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For the first time, results are presented on the prevalence of alcohol abuse and dependence in the United States in 1992, according to the most recent psychiatric classification of alcohol-related disorders from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). More than 7 percent of adults surveyed met DSM-IV criteria for 1-year alcohol abuse, alcohol dependence, or both. Males were almost three times more likely than females to meet the criteria for alcohol abuse and/or dependence; however, the male-to-female ratio was lowest in the youngest age group among nonblack respondents, suggesting that the rates of these disorders in nonblackfemales may be catching up.
This Epidemiologic Bulletin presents prevalence and population estimates of alcohol abuse and dependence in the United States for the year 1992. The definitions for these alcohol-related disorders were based on the most recent criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association [APA] 1994). Prevalence defines the weighted percentage of respondents classified with a DSM-IV diagnosis, and population estimate refers to the number of people in the United States receiving a DSM-IV diagnosis of alcohol abuse, alcohol dependence, or both. One-year prevalence estimates were derived from self-reports of symptoms of alcohol abuse and dependence on the 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES). The figures presented in this bulletin are the first estimates of DSM-IV alcohol abuse and dependence to be reported at the national level.
Background and Procedures
Prevalence and population estimates of alcohol abuse and dependence were based on the 1992 NLAES, a nationwide household survey sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Field work for the study was conducted by the Bureau of the Census. For the NLAES, direct face-to-face interviews were conducted with 42,862 respondents, 18 years of age and older, in the contiguous United States and the District of Columbia. The household-response rate for the NLAES was 91.9 percent, and the person-response rate was 97.4 percent.
The NLAES featured a complex multistage design (Massey et al. 1989). Primary sampling units (PSU's)(1) were stratified according to sociodemographic criteria and were selected with probability proportional to size. Approximately 2,000 PSU's were in the 1992 NLAES sample, 52 of which were self-representing-that is, selected with certainty. Within PSU's, geographically defined secondary sampling units, referred to as segments, were selected systematically for each sample. Oversampling of the black population was accomplished at this stage of sample selection. The decision to oversample the black population was based on the higher observed rates of alcohol-related disease (i.e., liver cirrhosis) in this group.
Segments then were divided into clusters of approximately four to eight housing units, and all occupied housing units were included in the NLAES. Within each household, one randomly selected respondent, 18 years of age or older, was selected to participate in the survey. Oversampling of young adults, 18-29 years of age, was accomplished at this stage of the sample selection to include a greater representation of this heavy drinking population subgroup. This subgroup of young adults was sampled at a ratio of 2.25 percent to 1.00.
Because of the complex survey design of the NLAES, variance estimation procedures that assume a simple random sample cannot be employed. Research has shown that clustering and stratification of the NLAES sample may result in standard errors much larger than those that would be obtained with a simple random sample of equal size. To take into account the NLAES sample design, all standard errors of …