Skip to Content
Bookmark and Share
Share
Home » Publications » Alcohol Epidemiologic Data Reference Manuals » Alcohol Epidemiologic Data Reference Manual, Volume 10

Print version

U.S. Alcohol Epidemiologic Data Reference Manual, Volume 10

ALCOHOL USE AND ALCOHOL USE DISORDERS IN THE UNITED STATES:
Main Findings From the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III)

April 2016

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. HHSN275201300016C for the operation of the Alcohol Epidemiologic Data System (AEDS) for 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.; Megan E. Slater, Ph.D.; and I-Jen P. Castle, Ph.D., of CSR, and Bridget F. Grant, Ph.D., Ph.D., of the Epidemiology and Biometry Branch of NIAAA. Rosalind A. Breslow, Ph.D., served as the NIAAA Contracting Officer’s Representative on the above-referenced contract and oversaw the preparation of this manual.


Public Domain Notice

All material appearing in this manual is in the public domain and may be reproduced or copied without permission from NIAAA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without NIAAA’s specific written authorization.

Recommended Citation

Chen, C.M., Slater, M.E., Castle, I-J.P., and Grant, B.F. 2016. Alcohol Use and Alcohol Use Disorders in the United States: Main Findings from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). U.S. Alcohol Epidemiologic Data Reference Manual, Volume 10, April 2016, NIH Publication No. 16-AA-8020. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism.

 

NIH Publication No. 16‑AA-8020

Printed April 2016

Table of Contents

List of Exhibits

List of Tables

Foreword

1. Introduction

2. Data Source

3. Data Coverage

3.1 NESARC-III Alcohol Items

3.1.1 Drinking Status

3.1.2 Drinking Level

3.1.3 Moderate Drinking

3.1.4 Exceeding Daily and Weekly Low-Risk Drinking Limits

3.1.5 Overall Beverage Preference

3.1.6 Drinking Onset

3.1.7 Family History of Alcoholism

3.1.8 Alcohol-Related Harmful Experience

3.1.9 DSM-5 Alcohol Use Disorders

3.1.10 Alcohol Treatment

3.2 Other NESARC-III Items

3.2.1 Basic Demographic and Background Information

3.2.2 Medical Conditions

3.2.3 Selected DSM-5 Psychiatric Disorders

4. Data Tables

4.1 Percent Distribution Tables for Alcohol Consumption, Experiences, and Treatment Utilization

4.2 Prevalence (%) Tables for Past-Year Medical Conditions

4.3 Prevalence (%) Tables for Psychiatric Disorders

4.4 Population Tables

5. References

List of Exhibits

Exhibit 1. Selected Questions on Alcohol Consumption in NESARC-III Questionnaire

Exhibit 2. Selected Questions on Family History of Alcoholism in NESARC-III Questionnaire

Exhibit 3. Selected Questions on Alcohol Experiences in NESARC-III Questionnaire

Exhibit 4. DSM-5 Alcohol Use Disorder Diagnostic Criteria and Associated Question Items in NESARC-III Questionnaire Section 2B

Exhibit 5. Selected Questions on Treatment Utilization in NESARC-III Questionnaire

Exhibit 6. Selected Demographic and Background Information in NESARC-III

Exhibit 7. Selected Questions on Medical Conditions in NESARC-III Questionnaire

List of Tables

1- Percent distribution of [variable], by sex, age group, and selected respondent characteristics, United States, 2012–2013

 Variables:

1.  Drinking status in the past year

2a. Average drinking level in the past year

2b. Average drinking level in the past year among past-year drinkers

3. Frequency of drinking 5+ drinks for males under age 65 or 4+ drinks for males ages 65 and older and females in a single day in the past year among past-year drinkers

4. Frequency of drinking 8+ drinks in a single day in the past year among past-year drinkers

5. Frequency of drinking 12+ drinks in a single day in the past year among past-year drinkers

6. Alcoholic beverage preference in the past year among past-year drinkers

7. Age at first drink among past-year drinkers

8. Family history of alcoholism among past-year drinkers

9. Alcohol-related harmful experience in the past year among past-year drinkers

10. DSM-5 alcohol use disorders in the past year among past-year drinkers

11. Receiving any alcohol treatment in the past year among past-year drinkers with DSM-5 alcohol use disorder

2- Prevalence (%) of selected past-year medical conditions, by sex, age group, and [variable], United States, 2012–2013

 Variables:

1.  Drinking status in the past year

2. Frequency of drinking 5+ drinks for males under age 65 or 4+ drinks for males ages 65 and older and females in a single day in the past year among past-year drinkers

3. Age at first drink among past-year drinkers

4. DSM-5 alcohol use disorder in the past year among past-year drinkers

3- Prevalence (%) of selected DSM-5 psychiatric disorders, by sex, age group, and [variable], United States, 2012–2013

 Variables:

1.  Drinking status in the past year

2. Frequency of drinking 5+ drinks for males under age 65 or 4+ drinks for males ages 65 and older and females in a single day in the past year among past-year drinkers

3. Age at first drink among past-year drinkers

4. DSM-5 alcohol use disorder in the past year among past-year drinkers

4-1. Population estimates (in 1,000s), by sex, age group, and selected respondent characteristics, United States, 2012–2013

4-2. Estimated numbers (in 1,000s) of past-year drinkers, by sex, age group, and selected respondent characteristics, United States, 2012–2013

Foreword

One of the most important tools in health policy and planning is good data. For this reason, it has been a priority of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health, to conduct the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). NESARC is the largest and most comprehensive survey to date on alcohol use, alcohol use disorders, related risk factors, and associated physical and psychiatric disabilities. Based on a nationally representative sample of adults in all 50 States and the District of Columbia of the U.S., the NESARC study provides important national alcohol, other substance use, and mental health statistics that can be used to inform development of effective strategies to reduce the harms from these conditions.

This manual is the 10th in a series produced by the Alcohol Epidemiologic Data System (AEDS) of NIAAA and presents main findings from NESARC-III, which includes data collected in 2012–2013.  The manual contains a comprehensive set of exhibits and tables that illustrate numerous aspects of alcohol use including age of alcohol use onset, frequency of at-risk drinking, alcohol-related harmful experiences, prevalence of DSM-5 Alcohol Use Disorders, and whether those with disorders received treatment.  It also presents data on past-year prevalence of relevant medical and psychiatric conditions.

Other volumes in the series include information on alcohol-related emergency department visits and hospitalizations, as well as co-occurring drug, mental health and related injuries; liver cirrhosis mortality; county alcohol problem indicators; hospital discharges with alcohol-related conditions; and State trends in drinking behaviors and alcohol-related mortality.

I strongly encourage the use of this and other Alcohol Epidemiologic Data Reference Manuals by individuals and groups requiring accurate and timely data for health services and prevention planning and research.

George F. Koob, Ph.D.
Director
National Institute on Alcohol Abuse and Alcoholism

1. Introduction

The National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) is NIAAA’s fourth national survey. The objectives and content areas of the NESARC-III that are similar to prior NIAAA surveys, including the 1991–1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES), the 2001–2002 Wave 1 NESARC, and the 2004–2005 Wave 2 NESARC, gather the data needed to assess alcohol use and associated problems in the general population, identify subgroups of the population at risk for alcohol use disorders and other alcohol-related problems, refine etiologic hypotheses, and form the basis of scientific evidence-based policies and prevention programs. As is the case with previous surveys, NESARC-III includes extensive questions on patterns of alcohol consumption as well as items designed to provide psychiatric classification of alcohol and drug use disorders and mental 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 NESARC-III. It uses a layout similar to an earlier data reference manual on findings from the 2001–2002 Wave 1 NESARC (Chen et al., 2006). The 2012–2013 NESARC-III and 2001–2002 Wave 1 NESARC cover similar issues in two time periods separated by about 10 years. Although both NESARC surveys were designed to provide nationally representative prevalence estimates for their respective periods, readers should note the differences in the sampling design, incentive procedure, response rates, sample size, and instrument of diagnostic interview when making simple, direct comparisons between data presented in the two manuals. For those interested in the changes in alcohol consumption and alcohol and drug use disorders based on these two surveys, please refer to the publications by Dawson and colleagues (2015), Grant and colleagues (2015a), and Hasin and colleagues (2015a).

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

2. Data Source

All data in this manual came from the 2012–2013 NESARC-III, a nationwide household survey that NIAAA designed and conducted. Westat completed the fieldwork for this survey under NIAAA’s direction, interviewing 36,309 respondents ages 18 and older in face-to-face household settings. The NESARC-III used a representative sample of the civilian, noninstitutionalized adult population in the United States, including all 50 States and the District of Columbia. The NESARC-III sample included people living in households and select noninstitutionalized group quarters, such as college dormitories, group homes, group quarters, and dormitories for workers. The sample also included veterans of the United States Armed Forces, but excluded those on active duty in the U.S. Armed Forces, Military Reserves, and National Guard. The household response rate for the NESARC-III was 72 percent, and the personal-level response rate was 84 percent, yielding an overall survey response rate of 60.1 percent.

The NESARC-III sample was selected using a four-stage, stratified probability sample design involving the selection of: (1) primary sampling units consisting of counties or groups of contiguous counties, (2) second-stage sampling units (segments), (3) dwelling units or household-equivalents in group quarters, and (4) eligible people within households occupying dwelling units. The NESARC-III respondent universe included the number of people in specific age, sex, and race-ethnicity domains derived from the 2012 American Community Survey public use files. NESARC-III oversampled Hispanics, non-Hispanic Blacks, and non-Hispanic Asians by means of oversampling geographic areas with high concentrations of these minority populations and giving minorities within sampled households greater probabilities of selection than nonminorities. This sampling strategy resulted in 7,037 Hispanics, 7,766 non-Hispanic Blacks, 1,801 non-Hispanic Asians, 19,194 non-Hispanic Whites, and 511 non-Hispanic American Indians/Alaska Natives out of the 36,309 respondents who completed the survey. NESARC-III used the NIAAA Alcohol Use Disorder and Associated Disabilities Interview Schedule, DSM-5 Version (AUDADIS-5) to assess the diagnostic definitions embodied in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association, 2013) (Grant et al., 2011). Subsamples of respondents who completed the NESARC-III were systematically re-interviewed using a shorter version of AUDADIS-5 and the Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 version (PRISM-5) to assess reliability and procedural validity, respectively (Grant et al., 2015b; Hasin et al., 2015b).

Details of the NESARC-III sampling design and methodology can be found in “Source and Accuracy Statement for National Epidemiologic Survey on Alcohol and Related Conditions-III” (Grant et al., 2014).

Because of the complex survey design employed by the NESARC-III, variance estimation procedures that assume a simple random sample may not be appropriate. Clustering in the NESARC-III 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-III sample design, all standard errors of estimates presented in this manual were generated using SAS-Callable SUDAAN (Research Triangle Institute, 2012), 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 and other selected information, as described in sections 3.1 and 3.2.

3.1 NESARC-III Alcohol Items

The primary focus of the NESARC-III 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

NESARC-III included screening questions to determine past-year drinking status. Only respondents who reported having at least one drink of any type of alcohol in the past year were considered to be past-year drinkers and were asked detailed questions about past-year alcohol consumption. Respondents who never had (or unknown if had) at least one drink in their life were considered to be lifetime abstainers; former drinkers were those who had at least one drink in their life but did not have (or unknown if had) at least one drink in the past year. Most of the tables in this manual are based on past-year drinkers only.

NESARC-III Questionnaire is available online at http://www.niaaa.nih.gov/research/nesarc-iii/questionnaire. Exhibit 1 shows the exact wording of questions used to determine drinking status (Questions 1 and 3 in Section 2A). Response alternatives and skip patterns are not shown in the exhibits.

3.1.2 Drinking Level

The NESARC-III 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 (Questions 5a through 8d in Exhibit 1). 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 (Card 26 through 29C, NIAAA, 2015). 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 the chart below shows:

Coolers

Wine

Wine/malt/liquor-based coolers

0.050

Regular wine

0.125

Hard lemonade

0.050

Champagne or sparkling wine

0.120

Hard iced tea

0.060

Fortified wine (including sherry, port, sake)

0.180

Hard cider

0.060

Low-alcohol fruit-flavored wine

0.060

Alcoholic energy drinks

0.080

Unknown

0.125

Prepackaged cocktails

0.125

   

Unknown

0.050

       

Beer

Liquor

Regular beer

0.050

80-proof liquor including brandy

0.400

Malt liquor

0.065

> 80–100-proof liquor

0.450

Lite or reduced calorie beer

0.042

> 100-proof liquor

0.750

Ice beer

0.055

Liqueurs or cordials

0.271

Unknown

0.050

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-III Data Notes (NIAAA, 2014), the algorithm for calculating the average daily volume of ethanol intake is as follows.  

  1. 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.)
  2. For respondents whose largest quantity of drinks was five 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.
  3. 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.
  4. For respondents whose largest quantity of drinks was six 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 five 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.
  5. Again, this sum of products was multiplied by the ethanol content per drink (see the chart of ethanol content per drink shown previously) 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.
  6. Assuming that one standard drink contains 0.60 ounces of ethanol, the average daily volume can be converted to the number of drinks.

3.1.3 Moderate Drinking

Based on the overall average daily volume of ethanol intake, past-year drinkers who drank up to 1.2 ounces of ethanol per day (i.e., up to 14 drinks per week) for males under age 65 and up to 0.6 ounces (i.e., up to 7 drinks per week) for females ages 18 and older and for males ages 65 and older were considered to be moderate drinkers (Meister, 1999).

3.1.4 Exceeding Daily and Weekly Low-Risk Drinking Limits

According to NIAAA’s low-risk drinking guidelines, males 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 females may be at risk if they drink more than 7 drinks per week or more than 3 drinks per occasion (NIAAA, 2010).

Questions 4h and 4f in NESARC-III Questionnaire Section 2A (Exhibit 1) ask about the frequency of drinking five or more drinks for both sexes and the frequency of drinking four or more drinks for females and for males ages 65 and older, respectively. In this manual, males under age 65 were considered to exceed daily low-risk drinking limits if they reported one or more occasions of drinking five or more drinks, or if their usual or largest ethanol intake on a single day exceeded 2.7 ounces (four-and-a-half standard drinks). Males ages 65 and older and females were considered to exceed daily limits if they reported one or more occasions of drinking four or more drinks, or if their usual or largest ethanol intake on a single day exceeded 2.1 ounces (three-and-a half standard drinks). Exceeding weekly low-risk drinking limits is defined as drinking, on average, more than 14 drinks per week (i.e., 2 drinks per day) for males under age 65 and more than 7 drinks per week (i.e., 1 drink per day) for males ages 65 and older and females.

3.1.5 Overall Beverage Preference

Questions 5a to 8d in NESARC-III Questionnaire Section 2A (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, as mentioned in section 3.1.2. 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.

3.1.6 Drinking Onset

Question 12a in NESARC-III Questionnaire Section 2A (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: ages 14 or younger, ages 15 to 17, ages 18 to 20, and ages 21 or older.

3.1.7 Family History of Alcoholism

NESARC-III asks questions about family history of alcoholism or problem drinking in the Questionnaire Section 2D (Exhibit 2). For these questions, an alcoholic or problem drinker was defined during the interview for each respondent as a person who has at least one of the following characteristics: physical or emotional problems because of drinking; problems with a spouse, family member, or friends because of drinking; problems at work or school because of drinking; problems because of driving after drinking; or spends a lot of time drinking or being hung over.

When referring to a relative who has been an alcoholic or problem drinker, this 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. In this manual, family history of alcoholism was categorized as having the following relatives as an alcoholic or problem drinker: “none,” “second-degree relatives only,” “first-degree relatives only,” and “both first- and second-degree relatives.” Respondents’ family members are included even if they were deceased at the time of the interview. Family members younger than age 10 and deceased family members who died before they reached age 10 are excluded. Nonblood relatives include spouses and domestic partners.

3.1.8 Alcohol-Related Harmful Experience

Exhibit 3 shows selected questions on some drinking-related experiences the respondents may have had in their lifetime. Specifically, these questions ask whether respondents more than once drove a car or other vehicle while drinking; drove a car, motorcycle, truck, boat, or other vehicle and had an accident while under the influence of alcohol; more than once drove a car, motorcycle, truck boat, or other vehicle after having too much to drink; and got into situations while drinking or after drinking that increased the chances of getting hurt—such as swimming, using machinery, or walking in a dangerous area or around heavy traffic. If the respondents answered yes to an experience, they were asked whether this experience happened in the past year.

Question 3b (4) of Section 2B (shown in Exhibit 3) asks whether respondents accidentally injured themselves or someone else other than via motor vehicle accidents, such as a bad fall or bad cut, while under the influence of alcohol in the past year.

Exhibit 1. Selected Questions on Alcohol Consumption in NESARC-III Questionnaire

Section 2A – ALCOHOL CONSUMPTION

The next questions are about drinking alcohol. This includes coolers; beer; wine; champagne; liquor such as whiskey, rum, gin, vodka, bourbon, tequila, scotch, brandy, cognac, cordials, or liqueurs; and also any other type of alcohol.

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, 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 FOUR OR MORE drinks in a single day? (females [any age] or males 65 years of age or older)

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

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

4k. And during the last 12 months, about how often did you drink TWELVE OR MORE drinks in a single day?

5a. During the last 12 months, did you drink any prepackaged alcoholic coolers?

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?

12a. About how old were you when you first started drinking, not counting small tastes or sips of alcohol?

Exhibit 2. Selected Questions on Family History of Alcoholism in NESARC-III Questionnaire

Section 2D - FAMILY HISTORY

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 because of driving after drinking (PAUSE) or a person who seems to spend a lot of time drinking or being hung over. (Repeat definition as needed.)

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.

Exhibit 3. Selected Questions on Alcohol Experiences in NESARC-III Questionnaire

Section 2B - ALCOHOL EXPERIENCES

1a. Now I’m going to ask you about some experiences you may have had with your drinking. As I read each experience, please tell me if this has ever happened to you. In your entire life, did you EVER ...

(33) More than once drive a car or other vehicle WHILE you were drinking?

(34) Drive a car, motorcycle, truck, boat, or other vehicle and have an accident WHILE you were under the influence of alcohol?

(35) More than once drive a car, motorcycle, truck, boat, or other vehicle AFTER having too much to drink?

(36) 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?

3a. In your ENTIRE LIFE, did you EVER ...

(4) Accidentally injure yourself or someone else in any way other than motor vehicle accidents, like a bad fall or bad cut, while you were under the influence of alcohol?

3b. Did this happen in the last 12 months?

3.1.9 DSM-5 Alcohol Use Disorders

The interview instrument used to diagnose alcohol use disorders in the NESARC-III is the AUDADIS-5, which is based on criteria articulated in the DSM-5 (American Psychiatric Association, 2013). Exhibit 4 presents the DSM-5 criteria for alcohol use disorder along with the questions from NESARC-III Questionnaire Section 2B that were used to determine whether a person meets a particular criterion. Reliability and procedural validity of the AUDADIS-5 measures for alcohol use disorders are extensively discussed elsewhere (Hasin et al., 2015b; Grant et al., 2015b).

A diagnosis of DSM-5 alcohol use disorder requires that a person show a problematic pattern of alcohol use leading to clinically significant impairment or distress, as demonstrated by meeting at least 2 of the 11 criteria. The occurrence of symptoms comprising at least two criteria has to cluster in the 12 months preceding the interview. The withdrawal criterion of the alcohol use disorder diagnosis was measured as a syndrome, requiring at least two of the eight symptoms of withdrawal to be positive as defined in the DSM-5, or one positive symptom of withdrawal relief/avoidance (e.g., taking a drink or medicine or drug to avoid or get over bad aftereffects of drinking). Based on the DSM-5 criteria met, alcohol use disorder severity levels can be classified as mild (two to three criteria), moderate (four to five criteria), or severe (six or more).

Exhibit 4. DSM-5 Alcohol Use Disorder Diagnostic Criteria and Associated Question Items in NESARC-III Questionnaire Section 2B

Diagnostic Criterion: Alcohol is often taken in larger amounts or over a longer period than was 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: There is a persistent desire or unsuccessful efforts to cut down or control alcohol use

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: A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or 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: Craving, or a strong desire or urge to use alcohol

Questionnaire Items:

  •  Feel a very strong urge or desire to drink.
  •  Want a drink so badly that you couldn’t think of anything else.

Diagnostic Criterion: Recurrent alcohol use resulting in a 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.
  •  Continue to drink even though it was causing you problems at school or at work.

Diagnostic Criterion: Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol

Questionnaire Items:

  •  Have arguments or problems with your spouse or partner or family or friends because of your drinking.
  •  Continue to drink even though it was causing you trouble with your family or friends.
  •  Get into physical fights while drinking or right after drinking.

Diagnostic Criterion: Important social, occupational, or recreational activities are given up or reduced because of alcohol use

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: Recurrent alcohol use in situations in which it is physically hazardous

Questionnaire Items:

  •  More than once drive a car or other vehicle WHILE you were drinking.
  •  Drive a car, motorcycle, truck, boat or other vehicle and have an accident WHILE you were under the influence of alcohol?
  •  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 use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol

Questionnaire Items:

  •  Continue to drink even though you knew it was making you feel depressed, uninterested in things, or suspicious or distrustful of other people.
  •  Continue 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.

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 or your hands trembling?
    3.  Feel anxious or nervous?
    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?
    6.  Find yourself sweating or your heart beating fast?
    7.  See, feel, or hear things that weren’t really there (when the effects of alcohol were wearing off)?
    8.  Have fits or seizures?
  •  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.

3.1.10 Alcohol Treatment

Exhibit 5 shows NESARC-III questions on 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 receiving any treatment for alcohol-related problems.

Exhibit 5. Selected Questions on Treatment Utilization in NESARC-III Questionnaire

Section 2C - 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, rabbi or any other religious counselor 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-III Items

Other NESARC-III variables not directly related to alcohol, but used for the analyses presented in this manual, are described in sections 3.2.1 to 3.2.3.

3.2.1 Basic Demographic and Background Information

Exhibit 6 shows demographic and background items from the NESARC-III that are included in this manual. These items include: sex, age, race/ethnicity, marital status, children under age 13 living in household, education, current full-time employment, family annual income, U.S. nativity, self-perceived health, health insurance coverage, urbanicity, and census region.


Exhibit 6. Selected Demographic and Background Information in NESARC-III

Sex

Male

Female

Age (years)

18–24

25–44

45–64

65+

Race/Ethnicity1

White, non-Hispanic

Black, non-Hispanic

American Indian/Alaska Native, non-Hispanic

Asian or Pacific Islander, non-Hispanic

Hispanic, any race

Marital Status

Married or cohabiting

Widowed, separated, or divorced

Never married

Children Under Age 13 Living in Household

Yes

No

Education

Less than high school

High school graduate or GED

Some college or higher

Currently Employed Full Time

Yes

No

Family Annual Income

Less than $20,000

$20,000–$34,999

$35,000–$69,999

$70,000 or more

Born in the United States

Yes

No

Self-Perceived Current Health

Excellent/Very good

Good

Fair/Poor

Currently Covered by Health Insurance

Yes

No

Urbanicity

Urban

Rural

Census region

Northeast

Midwest

South

West

1 The 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, 2014). Respondents who reported Hispanic or Latino origin were coded as Hispanic or Latino regardless of race. Non-Hispanic/Latino respondents who reported multiple races were coded into a single category in the following order of priority: 1) American Indian/Alaska Native, 2) Native Hawaiian/Pacific Islander, 3) Asian, 4) Black, and 5) White.

3.2.2 Medical Conditions

Exhibit 7 shows a list of medical conditions included in NESARC-III Questionnaire Section 14. Respondents were categorized as having a particular medical condition in the past year if they reported having the condition (Question 16a) and if a doctor or other health professional had diagnosed the condition (Question 16b).

Exhibit 7. Selected Questions on Medical Conditions in NESARC-III Questionnaire

Section 14 - MEDICAL CONDITIONS AND PRACTICES

16a. And now a few questions about your health. During the last 12 months, did you have . . .

  1.  Cirrhosis of the liver?
  2.  Any other form of liver disease?
  3.  Hardening of the arteries or arteriosclerosis?
  4.  Diabetes or sugar diabetes?
  5.  High blood pressure or hypertension?
  6.  High cholesterol?
  7.  High triglycerides?
  8.  Chest pain or angina?
  9.  Rapid heart beat or tachycardia?
  10.  A heart attack or myocardial infarction?
  11.  Any other form of heart condition or heart disease?
  12.  A stomach ulcer?
  13.  Any sexually transmitted diseases or venereal diseases like gonorrhea, syphilis, chlamydia or herpes?
  14.  Epilepsy or seizure disorder?
  15.  Arthritis?
  16.  A stroke?
  17.  Problems falling asleep or staying asleep?
  18.  Liver cancer?
  19.  Breast cancer?
  20.  Cancer of the mouth, tongue, throat or esophagus?
  21.  Any other cancer?
  22.  Anemia?
  23.  Fibromyalgia?
  24.  Reflex sympathetic dystrophy (RSD) or Complex Regional Pain Syndrome (CRPS)?
  25.  Any other nerve problem in your legs, arms or back?
  26.  Bowel problems, like inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS)?
  27.  Osteoporosis?
  28.  Lung problems like chronic bronchitis, emphysema, pneumonia, or influenza?
  29.  Pancreatitis?
  30.  Tuberculosis?
  31.  A serious or traumatic brain injury?

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

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

15a. Have you EVER been tested for HIV, the virus that causes AIDS, or tested for AIDS?

b. Did you EVER test positive for HIV or AIDS?

18a. In your ENTIRE life did you EVER attempt suicide?

c. How old were you the MOST RECENT time that happened?

3.2.3 Selected DSM-5 Psychiatric Disorders

In addition to alcohol use disorder, the AUDADIS-5 is designed to measure DSM-5 criteria for specific drug use disorders, tobacco use disorder, and selected mood, anxiety, trauma-related, eating, and personality disorders.

Drug use disorders include 10 separate categories of medicine and illicit drugs: sedatives, tranquilizers, opiates (other than heroin or methadone), stimulants, hallucinogens, cannabis, cocaine (including crack cocaine), inhalants/solvents, heroin, and other drugs (NESARC-III Questionnaire Section 3C). Sedatives, tranquilizers, opiates, and stimulants were counted only if used without or beyond the bounds of a prescription. Manifestation of at least 2 of the 11 criteria is required for a drug-specific use disorder diagnosis. The withdrawal criterion is not used for cannabis, hallucinogen, or inhalant use disorder diagnosis. For data tables presented in this manual, a diagnosis of any drug use disorder results from drug-specific diagnoses made for any of the 10 separate medicine/drug categories in a 12-month period.

Similar to DSM-5 alcohol and drug use disorders, a tobacco use disorder diagnosis requires the manifestation of at least 2 of the 11 criteria (NESARC-III Questionnaire Section 3A). Tobacco use disorder was assessed for any tobacco product, including cigarettes, cigars, pipes, snuff, chewing tobacco, e-cigarettes, and e-liquid.

Mood disorders included persistent depressive disorder (NESARC-III Questionnaire Section 4B) and major depressive disorder (Section 4A), mania (Section 5), and hypomania (Section 5). Anxiety disorders included panic disorder (Section 6), agoraphobia (Section 6A), social phobia (Section 7), specific phobias (Section 8), and generalized anxiety disorder (Section 9). Posttraumatic stress disorder (Section 12), anorexia nervosa (Section 17), bulimia nervosa (Sections 17 and 18), and binge-eating disorder (Section 18) were also assessed. Questionnaire Section 10 includes items to assess borderline and schizotypal personality disorders. Antisocial personality disorder is assessed together with conduct disorder in Section 11, as they share many overlapping symptoms.

To receive a formal DSM-5 diagnosis, a respondent needed to endorse a requisite number of symptoms pertaining to certain DSM-5 criteria. To facilitate analysis, the NIAAA psychiatric epidemiologists and colleagues constructed and provided ready-made diagnoses for all disorders in the NESARC-III data using DSM-5 disorder-specific algorithms. Consistent with DSM-5, prevalence estimates presented in the data tables are based on the past-year diagnoses that rule out substance-induced episodes or episodes due to a general medical condition. To receive a diagnosis for the DSM-5 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. Reliability and procedural validity of the substance use and psychiatric disorder modules of AUDADIS-5 are discussed elsewhere (Grant et al., 2015b).

4. Data Tables

Four types of data tables (i.e., Tables 1 to Tables 4) 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. 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, 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). For table cells with zero counts in the numerators, values are flagged by a “*” symbol. In Table 4.2, estimates based on fewer than 10 respondents (e.g., past-year drinkers ages 65 and older who had a DSM-5 alcohol use disorder and received any alcohol treatment in the past year) are suppressed and marked by a “–” symbol in the table cells.

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 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. The estimates may not be 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 four 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 for Alcohol Consumption, Experiences, and Treatment Utilization

Tables 1-1 through 1-11 present percent distributions of alcohol-related measures. The portion of Table 1-1 on the next page indicates that in the non-Hispanic White population ages 18 and older, 75.29 percent were past-year drinkers, 16.52 percent were former drinkers, and the remaining 8.19 percent were 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-III sample.

Similarly, the portion of Table 1-2a on the next page indicates that among non-Hispanic Whites ages 18 and older, 59.66 percent were moderate drinkers, and 40.98 percent exceeded NIAAA recommended daily and/or weekly low-risk drinking limits. These percentages add to more than 100 percent because these two categories are not mutually exclusive, and some of the past-year drinkers were moderate drinkers but exceeded NIAAA recommended daily and/or weekly low-risk drinking limits.


Table 1-1. [Percent distribution of drinking status in the past year]



Respondent characteristics


Both sexes

Sex

Male

Female

Estimate

S.E.

Estimate

S.E.

Estimate

S.E.

Total

Past-year drinker

72.71

0.63

76.67

0.61

69.03

0.76

Former drinker

16.21

0.36

15.45

0.44

16.91

0.41

Lifetime abstainer

11.09

0.44

7.88

0.38

14.06

0.58

Race/Ethnicity

White, non-Hispanic

Past-year drinker

75.29

0.81

77.93

0.79

72.81

0.98

Former drinker

16.52

0.45

15.89

0.57

17.12

0.50

Lifetime abstainer

8.19

0.54

6.18

0.44

10.08

0.73

Table 1-2a. [Percent distribution of average drinking level in the past year]



Respondent characteristics


Both sexes

Sex

Male

Female

Estimate

S.E.

Estimate

S.E.

Estimate

S.E.

Total

Moderate

58.44

0.53

59.86

0.59

57.12

0.64

Exceeded daily and/or weekly low-risk drinking limits

38.97

0.56

45.49

0.63

32.93

0.65

Race/Ethnicity

White, non-Hispanic

Moderate

59.66

0.63

59.51

0.72

59.79

0.78

Exceeded daily and/or weekly low-risk drinking limits

40.98

0.78

46.79

0.88

35.52

0.89

Table 1-2b. [Percent distribution of average drinking level in the past year among past-year drinkers]



Respondent characteristics


Both sexes

Sex

Male

Female

Estimate

S.E.

Estimate

S.E.

Estimate

S.E.

Total

Moderate

80.38

0.40

78.07

0.52

82.75

0.47

Exceeded daily and/or weekly low-risk drinking limits

53.60

0.56

59.33

0.70

47.71

0.68

Race/Ethnicity

White, non-Hispanic

Moderate

79.24

0.49

76.37

0.67

82.13

0.60

Exceeded daily and/or weekly low-risk drinking limits

54.43

0.73

60.04

0.91

48.78

0.87

It is important to remember that most of the percent distribution tables in this manual are based on past-year drinkers. As noted in the portion of Table 1-2b above, 79.24 percent of non-Hispanic White past-year drinkers ages 18 and older were moderate drinkers. This is not the same as saying that 79.24 percent of non-Hispanic Whites ages 18 and older were moderate drinkers. As shown in the portion of Table 1-2a, the percentage of non-Hispanic Whites ages 18 and older who were moderate drinkers is 59.66. The value of 59.66 can be obtained by multiplying the percent of past-year drinkers among the non-Hispanic White population ages 18 and older (75.29 from Table 1-1) by the percent of moderate drinkers among these past-year drinkers (79.24 from Table 1-2b) and then dividing the product by 100. Conversely, the percentages in Table 1-2a divided by the proportions of past-year drinkers can be used to derive the percentages in Table 1-2b. The percentages in Table 1-2b can also be derived by estimating the number of people in the numerator and denominator for each cell. 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.

In some tables, the sum of percentage distribution may be less than 100 because of missing values. An example is provided below in the portion of Table 1-5 showing the percentage distribution in 4 categories for various frequencies of drinking 12+ drinks in a single day. Among non-Hispanic Black females, the vast majority of past-year drinkers (95.98 percent) never engaged in this activity; 1.61 percent did so at least yearly but less than monthly; 0.47 percent did so monthly but less than weekly; and 1.75 percent did so weekly or more often. These percentages add to more than 99 percent, with the remainder representing a small number of past-year drinkers whose frequency of drinking 12+ drinks was unknown.

Table 1-5. [Percent distribution of frequency of drinking 12+ drinks in a single day in the past year among past-year drinkers]



Respondent characteristics


Both sexes

Sex

Male

Female

Estimate

S.E.

Estimate

S.E.

Estimate

S.E.

Race/Ethnicity

White, non-Hispanic

Never

88.42

0.40

81.22

0.67

95.65

0.28

At least yearly but less than monthly

6.26

0.27

10.07

0.49

2.43

0.20

Monthly but less than weekly

2.58

0.15

4.11

0.26

1.05

0.13

Weekly or more often

2.61

0.16

4.37

0.29

0.83

0.11

Black, non-Hispanic

Never

91.61

0.61

87.07

1.09

95.98

0.48

At least yearly but less than monthly

3.49

0.42

5.45

0.74

1.61

0.31

Monthly but less than weekly

1.22

0.19

2.01

0.34

#0.47

0.15

Weekly or more often

3.43

0.37

5.17

0.64

1.75

0.32

4.2 Prevalence (%) Tables for Past-Year Medical Conditions

Tables 2-1 through 2-4 show prevalence (i.e., percentages) of selected past-year medical conditions. In the portion of Table 2-4 shown below, the prevalence of cirrhosis of the liver among females with a mild DSM-5 alcohol use disorder is 0.32 percent. This means that for every 10,000 females ages 18 and older in the United States who had a mild DSM-5 alcohol use disorder, 32 reported having cirrhosis of the liver that a doctor or other health professional had diagnosed in the past year. However, the estimate is not reliable because it has a large standard error exceeding 30 percent of the estimate (i.e., relative standard error greater than 0.3), which is indicated by a “#” symbol. By comparison, it is estimated that no males ages 18 and older with a mild DSM-5 alcohol use disorder had cirrhosis of the liver; the “*” symbol next to the estimate indicates that no respondents reported this condition.

Table 2-4. [Prevalence (%) of selected past-year medical conditions, by sex, age group, and DSM-5 alcohol use disorder in the past year among past-year drinkers]



DSM-5 alcohol use disorders


Both sexes

Sex

Male

Female

Estimate

S.E.

Estimate

S.E.

Estimate

S.E.

Mild

Cirrhosis of the liver

#0.13

0.09

*0.00

0.00

#0.32

0.23

Other form of liver disease

0.86

0.21

#0.64

0.22

#1.19

0.42

Stomach ulcer

2.23

0.34

1.53

0.32

3.26

0.74

Diabetes or sugar diabetes

4.68

0.56

5.88

0.92

2.89

0.50

Pancreatitis

#0.03

0.02

#0.03

0.02

#0.04

0.04

Bowel problems, such as inflammatory bowel disease
(IBD) or irritable bowel syndrome (IBS)

3.03

0.48

#0.83

0.39

6.33

0.98

4.3 Prevalence (%) Tables for Psychiatric Disorders

Tables 3-1 through 3-4 show prevalence of selected past-year psychiatric disorders. In the portion of Table 3-1 below, the prevalence of major depressive disorder decreases with age, with 14.56 percent among past-year drinkers ages 18–24, 11.55 percent among ages 25–44, 10.60 percent among ages 45–64, and 5.58 percent among ages 65+. The prevalence estimates of manic episodic, hypomanic episode, and bipolar I disorder among past-year drinkers ages 65+ are 0.46 percent, 0.12 percent, and 0.48 percent, respectively, but are flagged for unreliability because their relative standard errors are greater than 0.3.

The portion of Table 3-4 below shows the prevalence of tobacco use disorder is 20.23 percent among male past-year drinkers with no DSM-5 alcohol use disorder. The prevalence estimates for cocaine use disorder and sedative use disorder in this group are not reliable, as indicated by the “#” symbol.

Table 3-1. [Prevalence (%) of selected DSM-5 psychiatric disorders, by sex, age group, and drinking status in the past year]



Drinking status in the past year

Age (years)

18—24

25—44

45—64

65+

Estimate

S.E.

Estimate

S.E.

Estimate

S.E.

Estimate

S.E.

Past-year drinker

Major depressive disorder

14.56

0.74

11.55

0.43

10.60

0.47

5.58

0.49

Persistent depressive disorder

3.26

0.39

2.91

0.18

4.04

0.28

1.92

0.29

Manic episode

2.39

0.29

1.96

0.16

1.07

0.12

#0.46

0.16

Hypomanic episode

1.14

0.23

0.80

0.12

0.36

0.07

#0.12

0.07

Bipolar 1 disorder

2.50

0.30

2.11

0.17

1.16

0.13

#0.48

0.16

Specific phobia

6.93

0.58

5.91

0.29

5.54

0.29

5.47

0.52

Social phobia

4.37

0.46

2.96

0.19

2.75

0.23

1.61

0.25

Panic disorder

3.50

0.38

4.24

0.23

2.93

0.25

0.90

0.20

Table 3-4. [Prevalence (%) of selected DSM-5 psychiatric disorders, by sex, age group, and DSM-5 alcohol use disorder in the past year among past-year drinkers]



DSM-5 alcohol use disorders


Both sexes

Sex

Male

Female

Estimate

S.E.

Estimate

S.E.

Estimate

S.E.

None

Tobacco use disorder

18.19

0.47

20.23

0.58

16.29

0.54

Any drug use disorder

2.39

0.12

2.87

0.20

1.95

0.16

Cannabis use disorder

1.49

0.09

2.03

0.19

0.99

0.14

Opioid use disorder

0.56

0.06

0.54

0.09

0.59

0.08

Cocaine use disorder

0.15

0.03

#0.16

0.06

0.14

0.03

Sedative use disorder

0.24

0.04

#0.18

0.06

0.30

0.06

4.4 Population Tables

Tables 4-1 and 4-2 show the populations (in thousands) represented by the percent distributions and prevalence estimates in the earlier tables. Table 4-1 presents the total population of the United States ages 18 and older, and Table 4-2 shows the portion of this population who were past-year drinkers at the time the NESARC-III 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 medical condition prevalence tables to derive estimates of the number of people in each of the specific categories, as illustrated by the following examples.

As noted earlier in Table 1-1, 75.29 percent of non-Hispanic Whites ages 18 and older were past-year drinkers in 2012–2013. The portion of Table 4-1 shown on the next page indicates that the overall population for this cell was 155,814 thousand when the NESARC-III was conducted. Multiplying 155,814 thousand by 75.29 percent can be used to approximate the estimated 117,308 thousand past-year drinkers shown in Table 4-2. Table 1-2a shows that 80.38 percent of past-year drinkers ages 18 years and older were moderate drinkers. The estimated 171,159 thousand past-year drinkers ages 18 years and older times 80.38 percent approximates the estimated 137,573 thousand moderate drinkers shown in Table 4-2.

The population estimates in Tables 4-1 and 4-2 can be used in a similar way with the medical condition prevalence estimates in Tables 2-1 through 2-4 and with the psychiatric disorder prevalence estimates in Tables 3-1 through 3-4. As mentioned above, the prevalence of past-year cirrhosis of liver is 0.32 percent among female past-year drinkers ages 18 and older with a mild DSM-5 alcohol use disorder (from Table 2-1). Multiplying the total number of females in this group (6,861 thousand, from the portion of Table 4-2 below) by 0.32 percent yields an estimate of 22 thousand females in this group who were diagnosed with cirrhosis of liver in the past year, although the estimate is not reliable because its relative standard error is greater than 0.3.

Table 4-1. [Population estimates (in 1000s), by sex, age group, and selected respondent characteristics]



Respondent characteristics


Both sexes

Sex

Male

Female

Estimate

S.E.

Estimate

S.E.

Estimate

S.E.

Total

235,412

2,622

113,212

1,470

122,200

1,499

Race/Ethnicity

White, non-Hispanic

155,814

3,250

75,485

1,642

80,329

1,830

Black, non-Hispanic

27,752

1,381

12,469

604

15,283

830

American Indian/Alaska Native, non-Hispanic

3,668

292

1,492

135

2,177

220

Asian/Native Hawaiian/Other Pacific Islander, non-Hispanic

13,486

1,106

6,508

560

6,978

591

Hispanic, any race

34,692

1,581

17,258

821

17,434

815

Table 4-2. [Estimated numbers (in 1,000s) of past-year drinkers, by sex, age group, and selected respondent characteristics]

Respondent characteristics


Both sexes

Sex

Male

Female

Estimate

S.E.

Estimate

S.E.

Estimate

S.E.

Total

171,159

2,509

86,804

1,369

84,355

1,429

Race/Ethnicity

White, non-Hispanic

117,308

2,617

58,824

1,362

58,484

1,458

Black, non-Hispanic

18,345

870

8,996

457

9,350

459

American Indian/Alaska Native, non-Hispanic

2,710

223

1,120

105

1,590

170

Asian/Native Hawaiian/Other Pacific Islander, non-Hispanic

8,425

718

4,722

446

3,702

316

Hispanic, any race

24,371

1,090

13,142

625

11,229

524

Average drinking level in the past year among past-year
drinkers

Moderate

137,573

2,119

67,768

1,177

69,805

1,250

Exceeded daily and/or weekly low-risk drinking limits

91,748

1,613

51,503

926

40,245

900

DSM-5alcohol use disorders in the past year among past-year
drinkers

None

138,511

2,247

66,833

1,251

71,678

1,252

Any

32,648

790

19,971

494

12,677

450

Mild

17,125

500

10,264

344

6,861

303

Moderate

7,604

300

4,602

233

3,002

174

Severe

7,919

286

5,105

206

2,814

163

A similar calculation using data from Table 3-4 (20.23 percent had DSM-5 tobacco use disorder among male past-year drinkers ages 18 and older who had no DSM-5 alcohol use disorder) and Table 4-2 (66,833 thousand male past-year drinkers ages 18 and older who had no DSM-5 alcohol use disorder) yields an estimate that 13,520 thousand males who had no DSM-5 alcohol use disorder had a diagnosis of tobacco use disorder.

5. References

American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, D.C.: APA.

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

Dawson, D.A., Goldstein, R.B., Saha, T.D., & Grant, B.F. (2015). Changes in alcohol consumption: United States, 2001–2002 to 2012–2013. Drug and Alcohol Dependence, 148:56–61.

Grant, B.F., Goldstein, R.B., Chou, S.P., Saha, T.D., Ruan, W.J., Huang, B., Smith, S.M., Zhang, H., Jung, J., Pickering, R.P., Aivadyan, C., Greenstein, E., & Hasin, D.S. (2011).The Alcohol Use Disorder and Associated Disabilities Interview Schedule—Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Version (AUDADIS-5). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism.

Grant, B.F., Chu, A., Sigman, R., Amsbary, M., Kali, J., Sugawara, Y., Jiao, R., Ren, W., & Goldstein, R. (2014). Source and Accuracy Statement: National Epidemiologic Survey on Alcohol and Related Conditions–III (NESARC-III).Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism.

Grant, B.F., Goldstein, R.B., Saha, T.D., Chou, S.P., Jung, J., Zhang, H., Pickering, R.P., Ruan, W.J., Smith, S.M., Huang, B., & Hasin, D.S. (2015a).Epidemiology of DSM-5 alcohol use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry, 72:757–766.

Grant, B.F., Goldstein, R.B., Smith, S.M., Jung, J., Zhang, H., Chou, S.P., Pickering, R.P., Ruan, W.J., Huang, B., Saha, T.D., Aivadyan, C., Greenstein, E., & Hasin, D.S. (2015b). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5): Reliability of substance use and psychiatric disorder modules in a general population sample. Drug and Alcohol Dependence, 148:27–33.

Hasin, D.S., Saha, T.D., Kerridge, B.T., Goldstein, R.B., Chou, S.P., Zhang, H., Jung, J., Pickering, R.P., Ruan, W.J., Smith, S.M., Huang, B., Grant, B.F. (2015a). Prevalence of marijuana use disorders in the United States between 2001–2002 and 2012–2013. JAMA Psychiatry, 72:1235–1242.

Hasin, D.S., Greenstein, E., Aivadyan, C., Stohl, M., Aharonovich, E., Saha, T., Goldstein, R., Nunes, E.V., Jung, J., Zhang, H., & Grant, B.F. (2015). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5): Procedural validity of substance use disorders modules through clinical re-appraisal in a general population sample. Drug and Alcohol Dependence, 148:40–46.

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

Meister, K. (1999). Moderate Alcohol Consumption and Health. New York: American Council on Science and Health.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2010). Rethinking Drinking: Alcohol and Your Health. NIH Publication No. 10-3770. Washington, D.C.: U.S. Department of Health and Human Services.

NIAAA. (2014). NESARC-III Data Notes. Available at: http://www.niaaa.nih.gov/sites/default/files/NESARC-III%20Data%20Notesfinal_12_1_14.pdf. Accessed January 20, 2016. Bethesda, MD: NIAAA.

NIAAA. (2015). National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) Flashcard Booklet. Available at: http://www.niaaa.nih.gov/sites/default/files/flashcards_glasses_with_description_FINAL_1_6_15.pdf. Accessed January 20, 2016. Bethesda, MD: NIAAA.

Research Triangle Institute (RTI). (2012). Software for Survey Data Analyses (SUDAAN) Release 11. Research Triangle Park, NC: RTI.