(Reuters Health) - Roughly three in 10 U.S. adults have a drinking problem or have misused alcohol at some point in the past, a large study finds.
And less than one in five people with symptoms of addiction or dependence received treatment for the problem, according to survey responses from more than 36,000 adults nationwide who were asked about their alcohol consumption.
“The stigma of alcohol problems is a major barrier to getting treatment,” senior study author Deborah Hasin, an epidemiology professor at Columbia University in New York, said by email.
Hasin and colleagues focused their analysis on a medical condition known as alcohol use disorder, which is diagnosed based on the impact drinking has on daily life. Symptoms can include drinking more or longer than intended; finding that alcohol is negatively impacting family, work or school; and making dangerous choices such as driving while intoxicated or having unprotected sex.
While the condition is diagnosed based on the impact of alcohol rather than a set number of drinks, women can limit their risk of developing a problem if they consume no more than three drinks in one day or seven over the course of a week, according to the National Institute on Alcohol Abuse and Alcoholism. For men to minimize risk, the cap should be four drinks in one day or no more than 14 per week.
One drink in this scenario could be a 12-ounce beer, a 5-ounce glass of wine or 1.5-ounce shot of hard liquor.
Generally, if people misused alcohol, the problem emerged around age 26, the study found. People with the most severe addiction tended to develop symptoms by age 23, while more mild dependence generally surfaced around age 30.
Overall, men and white adults were more likely to develop an alcohol problem than women or minorities, but Native Americans had greater rates of severe addiction than whites.
Married or cohabiting couples were less likely to drink excessively than divorced or single adults.
Poverty made drinking more likely, with higher rates of serious drinking problems among low-income people than among those at the highest income levels.
Education also made a difference. Compared with people who attended college, adults who didn’t complete high school had greater odds of experiencing severe alcohol problems within the past 12 months, the study found.
After controlling for factors such as marital status, income and education, drinking problems were associated with other substance abuse disorders as well as with depression and bipolar disorder, the researchers report in JAMA Psychiatry.
“Although people often report drinking alcohol to self-medicate a psychiatric disorder, heavy drinking can also cause psychiatric symptoms,” Dr. Henry Kranzler, director of the Center for Studies of Addiction at the University of Pennsylvania, said by email.
Genetics can also play a role in making people more susceptible to both addiction and depression, said Alexis Edwards, a researcher at Virginia Institute of Psychiatric and Behavioral Genetics at Virginia Commonwealth University who wasn’t involved in the current study.
“We know that the liability to alcohol use disorder is influenced by genetics, and so is liability to basically every other psychiatric and substance use disorder,” Edwards said.
Researchers and clinicians focus on the impact of alcohol rather than on a specific number of drinks consumed because the outcomes of excessive use can vary and people often underestimate how much they drink, Hasin said.
“Drinking a nightly single glass of wine would be considered a low-risk pattern by almost any standard,” Hasin said. “For people who have several drinks at a party or a ball game, the answer isn’t that simple.”
People who have less severe problems with alcohol may not recognize that they are drinking to excess, said James MacKillop, a researcher in psychiatry and neuroscience at DeGroote School of Medicine at McMaster University in Ontario who wasn’t involved in the study.
“In my experience, individuals with moderate and severe alcohol use disorders would generally meet the colloquial definition of alcoholism, MacKillop said by email. “Individuals with mild alcohol use disorders are necessarily experiencing some level of alcohol-related impairment, but are less likely to self-identify as having alcoholism and may not meet the general perception of an alcoholic.”
SOURCE: bit.ly/1JzqIZ5 JAMA Psychiatry, online June 3, 2015.