Low Prevalence of Alcohol Dependence Among US Adult Drinkers

"This study found that about 9 of 10 adult excessive drinkers did not meet the diagnostic criteria for alcohol dependence. About 90% of the adults who drank excessively reported binge drinking, and the prevalence of alcohol dependence was similar among excessive drinkers and binge drinkers across most sociodemographic groups. The prevalence of alcohol dependence also increased with the frequency of binge drinking. However, even among those who reported binge drinking 10 or more times in the past month, more than two-thirds did not meet diagnostic criteria for alcohol dependence according to their responses to the survey.

"The prevalence of alcohol dependence among adult excessive drinkers and binge drinkers in this study was slightly higher than the prevalence reported in other studies using the same diagnostic criteria for the classification of alcohol dependence. A 2001 study of alcohol abuse and dependence among US adults using the National Household Survey on Drug Abuse (NHSDA) — the precursor to the NSDUH — found that the prevalence of alcohol dependence was 7.4% among men and 7.3% among women who reported binge drinking (13). The higher prevalence of alcohol dependence among binge drinkers in this study may be due to the different time period as well as differences in the survey methods, which make these estimates not directly comparable (14). The former NHSDA was redesigned in 1999, and other changes were made to the survey in 2002, which may have increased the sensitivity of the NSDUH for identifying people who are binge drinking and alcohol dependent.

"Differences in the prevalence of alcohol dependence between the current study and the 2002 study in New Mexico (10.7% among excessive drinkers and 8.1% among binge drinkers) (8) are probably due to differences in the survey methods used by the NSDUH and the BRFSS as well as differences in the populations studied (15).

"Consistent with previous studies, binge drinking was most common among men, those aged 18 to 24, non-Hispanics whites, those with some college education, and those with an annual family income $75,000 or more (16). In contrast, alcohol dependence was most common among American Indians or Alaskan Natives, those having less than a high school education, and those with an annual family income of less than $25,000. These findings may reflect the known impact of alcohol dependence on many areas in the drinker’s life, including their ability to work and their productivity in the workplace. Reduced workplace productivity is the single largest contributor to alcohol-attributable economic costs in the United States (1).

"The strong relationship between the prevalence of excessive drinking and binge drinking is also consistent with the findings of previous studies (17), as is the higher prevalence of alcohol dependence among binge drinkers relative to all current drinkers (8), and the positive relationship between the frequency of binge drinking and alcohol dependence (18). These findings emphasize the usefulness of screening for binge-level alcohol consumption to identify excessive drinking among adults, including those who are alcohol-dependent (19). The relatively low prevalence of alcohol dependence among people who drink excessively also suggests that most people who are screened for excessive drinking in clinical settings will probably not need to be referred for specialized treatment."