Conflicting Alcohol Use Disorder Data Represents a Major Gap in Public Health Information
Author: Mark Gold, MD
Recent television commercials for a national beer brand sums up the alcohol problem in the United States. Beautiful young people gather at beautiful places to socialize and drink. The message is: Drinking is an essential ingredient for a “good time”. So, yes, the drinking culture is alive and well in the US, but the real drinkers are not faring so well.
So, the controversy of the recent research reported in JAMA Psychiatry on August 2017 concerning alcohol consumption is like re-arranging the deck chairs on the Titanic. People are dying well before their time from this disease.
JAMA reported that the number of Americans who drink excessively has shot up dramatically. The article titled “Remarkable Increases in Alcohol Use Disorders” suggests that the rate of alcohol use disorder (AUD) in the US surged by over 49% between 2001-2002 and 2012-2013. The results documented substantial increases in the prevalence of past 12-month drinking, high-risk drinking and Alcohol Use Disorders (AUDs). The most dramatic increase was related to the most serious problems.
Overall, AUD increased from 8.5% in 2001-2002 to 12.7% a decade later. These data were limited to the past 12-month or current AUD diagnoses.
The findings of the study were the result of an evaluation of drinking patterns of thousands of American adults attained by the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).
Soon after the study was published in JAMA, a number of real experts have disputed the conclusions and questioned the methods of study. This point of view is supported by a number of other findings, including another federal survey released by the National Survey on Drug Use and Health (NSDUH) which reported a reduction in the AUD rate.
Richard Grucza, MD, from the Washington University School of Medicine who compared the two studies states, “The NSDUH methods are much more consistent from year-to-year and it is administered annually. So I tend to put more weight on NSDUH data.”
In addition, NESARC had changed some questions asked in 2013 from those in 2001, which would lead participants to respond differently. Moreover, Government Census Bureau workers were used in the first survey and private workers during the 2012-2013 survey which would impact the outcome.
Why Does This Matter?
The short answer is sufficient. In point of fact, it appears drug use is decreasing among young people. Surveys are only as good as the questions and truthfulness of responses. Conclusions are only as good as the investigators. We need accurate data from which to measure the size and scope of AUDs and as a yardstick of public policy and treatment efficacy.
While I am pretty sure that Grucza is correct, we should not lose sight of the fact that alcoholism remains a major public health issue. According to the National Institute on Alcoholism and Alcohol Abuse, nearly 88,000 people die from alcohol-related causes annually, which is the fourth leading preventable cause of death in the US—and binge drinking among young people is epidemic. Years of potential life lost (YPLL) data from the CDC should tell us all we need to know about alcohol abuse and teens. Alcohol related trauma is the leading cause of death for teenage males and young adult males, who should live well into their 7th decade.
The statistical discrepancies between surveys and agencies will be remedied and no one will be harmed in the process. But we can ill afford to take our eye off the ball and be distracted when the mortality and morbidity rate from SUDs is this high.