Population projections using DSM-III criteria: alcohol abuse and dependence, 190-2000 - Diagnostic and Statistical Manual of Mental Disorders

Alcohol Health & Research World,  Fall, 1989  by Gerald D. Williams,  Bridget F. Grant,  Thomas C. Harford,  John Noble

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Population Projections Using DSM-III Criteria

Alcohol Abuse and Dependence, 1990-2000

If the prevalence rates of alcohol abuse and alcohol dependence remain at their current levels, then the combined number of individuals who meet the diagnostic criteria for alcohol abuse and dependence will rise from 15.1 million in 1990 to 15.4 million by the year 2000. The number of alcoholics is projected to increase from 9.1 million to 9.4 million, while the number of alcohol abusers is projected to remain relatively stable, at approximately 6.0 million. These projections do not take into account the advances in treatment and prevention that arise from biological and clinical research, advances that surely will continue to be made between now and the year 2000.

This Epidemiologic Bulletin presents detailed population projections of alcohol abuse and dependence for the years 1990, 1995, and 2000. The diagnostic categories of alcohol abuse and alcohol dependence are based upon the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) criteria (American Psychiatric Association 1980). Twelve-month prevalence estimates of alcohol abuse and dependence were derived from self-reports of symptoms of alcohol abuse and dependence included in the 1984 national survey on alcohol use (Grant and Harford 1989). Population projections were based on data from the Bureau of the Census for resident, civilian, noninstitutionalized persons 18 years of age and older (U.S. Bureau of the Census 1989).

BACKGROUND AND PROCEDURES

Prevalence estimates of alcohol-use disorders were based on data from the seventh national general population survey on alcohol use conducted by the Alcohol Research Group in 1984, under a grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Direct interviews were completed with a general population sample of 5,221 adults aged 18 years and older within the contiguous 48 States. The response rate was 74.2 percent. This multistage probability survey was designed to provide adequate samples of blacks and Hispanics suitable for cross-ethnic comparative analyses. Because of the oversampling of blacks and Hispanics, differential sampling within households, and varying completion rates by sex, age, and the four census regions, new weights were assigned to the sample in this report to provide estimates that could be generalized to the U.S. population as a whole.

The analytic procedures used to construct the projections were identical to those used in an earlier report (Williams et al. 1987). A cohort component method was used, in which rates of alcohol abuse and dependence from the 1984 national survey were applied to population data on selected sex, age, and racial groups for the years 1990, 1995, and 2000 (U.S. Bureau of the Census 1984; Raymondo 1989). The procedure is similar to the method used by Marden (1973) to estimate alcohol treatment needs among local, State, and national populations.

The prevalence rates themselves, however, were derived in a manner substantially different from that used in the earlier projections report. In that report, the prevalence rates for alcohol abuse and alcoholism were established by Guttman scaling of responses to alcohol dependence and drinking consequence items collected in the 1979 national survey (Harford and Parker 1985). The definitions of alcohol abuse and alcohol dependence used were only partially based on DSM-III criteria because no item was available to operationalize tolerance, a central criterion for alcohol dependence.

DSM-III CLASSIFICATION

Diagnoses of DSM-III alcohol abuse and alcohol dependence were derived by matching each of the diagnostic criteria of the disorders with symptom items (those experienced during the year preceding the interview) appearing on the 1984 survey questionnaire. As a result of this process, all four abuse and dependence criteria were operationalized (Sidebar).

According to the DSM-III, a diagnosis of alcohol abuse requires a pattern of pathological alcohol use (7 items available), plus impairment in social or occupational functioning due to alcohol use (22 items). A diagnosis of alcohol dependence requires either a pattern of pathological use or impairment in social or occupational functioning, plus evidence of tolerance (1 item) or withdrawal (4 items). The DSM-III alcohol abuse and dependence groups formed from the 1984 survey were mutually exclusive; that is, alcohol abusers did not meet criteria for alcohol dependence, and those who met criteria for alcohol dependence were considered alcohol dependent whether or not they also met the criteria for alcohol abuse. A more detailed explication of the diagnostic algorithms is presented in Grant and Harford 1989.

KNOWN DEMOGRAPHIC CHANGES

The projections in this Epidemiologic Bulletin were based upon demographic changes that are expected in the resident, civilian, noninstitutional population aged 18 and older between the years 1990 and 2000. Over the next decade, the number of young adults aged 18 to 29 years will decreased by slightly more than 10 percent. The number of persons 30 to 44 years of age, however, will increase between 1990 and 1995, and then decrease slightly from 1995 to 2000.