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Alcohol Use Disorders and Co-occurring Conditions

Alcohol Use Disorders and Co-occurring Conditions. Ting-Kai Li, M.D. Director National Institute on Alcohol Abuse and Alcoholism National Institutes of Health Department of Health and Human Services Complexities of Co-occurring Disorders

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Alcohol Use Disorders and Co-occurring Conditions

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  1. Alcohol Use Disorders and Co-occurring Conditions Ting-Kai Li, M.D. Director National Institute on Alcohol Abuse and Alcoholism National Institutes of Health Department of Health and Human Services Complexities of Co-occurring Disorders Harnessing Services Research to Improve Care for Mental, Substance Use, and Medical/Physical Disorders June 24, 2004

  2. Presentation Overview • Extent of the Problem • Alcohol and Co-occurring Conditions • Onset of Alcohol Use and Alcohol Use Disorders • Screening and Brief Intervention • Conclusion

  3. Extent of the Problem In the United States: • 18 million Americans suffer from alcohol abuse or dependence – 100,000 die annually • One in four children under age 18 is exposed to family alcohol problems • Between 20%-40% of hospital admissions are alcohol-related • Alcohol problems cost U.S. society an estimated $185 billion annually

  4. Disease Burden by Illness - DALY United States, Canada and Western Europe, 200015 - 44 year olds

  5. Cumulative Distribution of Alcohol Consumption in the United States

  6. Why Some People Drink/Do Not Drink • Reinforcing Effects • Positive • Negative • Aversive Effects • Peer/Cultural Influences

  7. Negative Reinforcement tension reduction stress dampening The Self-Medication Hypothesis Drinking to obtain relief from: stress anxiety depression dysphoria

  8. Pharmacodynamic Effects on Central Nervous System

  9. Co-Occurrence of Current (12-month) Alcohol Dependence and Nicotine and Any Drug Dependence

  10. Co-Occurrence of Current (12-month) DSM-IV Alcohol Dependence and Mood and Anxiety Disorders NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003.

  11. Co-occurrence of Current (12-month) DSM-IV Alcohol Dependence and Personality Disorders NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003.

  12. 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 5 10 15 20 25 30 35 40 45 50 Age Age at Onset: DSM-IV Age of First Use of Alcohol Percentage in each age group who begin using alcohol Source: NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003

  13. Prevalence of Lifetime Alcohol Dependence by Age of First Alcohol Use and Family History of Alcoholism Grant and Dawson. J Subst Abuse. 1998;10(2):163-73.

  14. Age of Onset: Alcohol Dependence Age at Onset of DSM-IV Alcohol Dependence

  15. Prevalence of past-year DSM-IV alcohol dependence: United States, 2001-2002: Grant, B.F. et al., Drug and Alcohol Dependence, in press 2004.

  16. Percentage in each age group who develop a first-time cannabis use disorder Age at Onset of DSM-IV Cannabis Use Disorders Source: NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003

  17. Age at Onset: DSM-IV Tobacco Dependence

  18. Age at Onset of DSM-IV Major Depression Source: NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003

  19. Age of Onset of Brain Disorders

  20. Conclusion • The striking similarity in the age of onset of diagnosablecases of alcohol dependence, cannabis use disorder, tobacco dependence, and major depression is a critical window of opportunity for preventing alcohol abuse and dependence • Understanding the relationship of alcohol use to environmental influences (e.g., stress) and co-occurring conditions (e.g., depression) requires longitudinal studies of: • the relatives of singly and dually affected subjects (high-risk subjects design), and • the developmental trajectory of these disorders and drug use disorders in children and adolescents (general population design)

  21. The USPSTF: recommends screening and behavioral counseling interventions to reduce alcohol misuse by adults, including pregnant women, in primary care settings(B recommendation) concludes that there is insufficient evidence to recommend interventions to prevent or reduce alcohol misuse by adolescents in primary care settings (I recommendation) U.S. Preventive Services Task Force. Screening and Behavioral Counseling Interventions in Primary Care To Reduce Alcohol Misuse: Recommendation Statement. Annals of Internal Medicine 2004;140:554-556 U.S. Preventive Services Task Force (USPSTF) Recommendations on Screening and Behavioral Counseling Interventions in Primary Care To Reduce Alcohol Misuse .

  22. New Proposed Science-Based Screening Guidelines

  23. AUDIT-C1

  24. NIAAA NIAAA NIAAA NIAAA NIAAA NIAAA NIAAA NIAAA A Simple, Effective Screening Protocol (Proposed)

  25. NIAAA NIAAA NIAAA NIAAA NIAAA NIAAA NIAAA NIAAA A Simple, Effective Screening Protocol (Proposed)

  26. Conclusion Study interventions to prevent or reduce alcohol misuse by adolescents in primary care and other settings

  27. Acknowledgements Bridget F. Grant Ph.D., Ph.D. Charlene Le Fauve, Ph.D. Brenda G. Hewitt

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