In DSM-IV, an alcohol abuse diagnosis is preempted
by dependence, although the symptoms of each disorder are different. Consequently,
little is known about the extent to which dependence occurs with or without
abuse. The distinction is important because of potential heterogeneity in
dependence as a phenotype in genetic research, as well as potential underestimation
of alcohol dependence when surveys cover dependence symptoms only among those
who screen positive for alcohol abuse.
To present the prevalence of DSM-IV alcohol
dependence with and without alcohol abuse in national and population subgroups.
The United States, including Alaska, Hawaii, and the District of Columbia.
Household and group-quarters residents, 18 years and older, in the National
Epidemiologic Survey on Alcohol and Related Conditions (N = 42 392).
Main Outcome Measures
DSM-IV alcohol dependence with and without DSM-IV alcohol abuse, assessed with the Alcohol Use Disorder
and Associated Disabilities Interview Schedule.
Among respondents with current alcohol dependence, 33.7% did not additionally
meet criteria for abuse (29.0% among men and 46.1% among women). Current dependence
without abuse was especially common among minority women (48.5% among African
Americans, 55.2% among Hispanics). Among respondents with lifetime diagnoses
of dependence, 13.9% did not additionally meet criteria for abuse (10.1% among
men, 22.1% among women): proportions were highest among minorities, eg, 29.1%
among Hispanic women and 19.2% among Hispanic men.
Alcohol abuse does not always accompany alcohol dependence in the general
population, especially among women and minorities. Dependence with and without
abuse may represent heterogeneous phenotypes for genetic research. Use of
alcohol abuse as a screening method for alcohol dependence in large epidemiologic
studies will differentially underestimate the prevalence of dependence by
subgroup, affecting time trend and comorbidity research. Such underestimation
may also perpetuate a lack of services for traditionally underserved groups.