Background Current and comprehensive information on the epidemiology of DSM-IV 12-month and lifetime drug use disorders in the United States has not been available. Objectives To present detailed information on drug abuse and dependence prevalence, correlates, and comorbidity with other Axis I and II disorders. Design, Setting, and Participants Face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule of the National Institute on Alcohol Abuse and Alcoholism in a large representative sample of US adults (N = 43 093). Main Outcome Measures Twelve-month and lifetime prevalence of drug abuse and dependence and the associated correlates, treatment rates, disability, and comorbidity with other Axis I and II disorders. Results Prevalences of 12-month and lifetime drug abuse (1.4% and 7.7%, respectively) exceeded rates of drug dependence (0.6% and 2.6%, respectively). Rates of abuse and dependence were generally greater among men, Native Americans, respondents aged 18 to 44 years, those of lower socioeconomic status, those residing in the West, and those who were never married or widowed, separated, or divorced (all P Conclusions Most individuals with drug use disorders have never been treated, and treatment disparities exist among those at high risk, despite substantial disability and comorbidity. Comorbidity of drug use disorders with other substance use disorders and antisocial personality disorder, as well as dependence with mood disorders and generalized anxiety disorder, appears to be due in part to unique factors underlying each pair of these disorders studied. The persistence of low treatment rates despite the availability of effective treatments indicates the need for vigorous educational efforts for the public and professionals.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/482282/yoa60081_566_576.pdf

Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Alcohol Abuse and Dependence in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Background Uncertainties exist about the prevalence and comorbidity of substance use disorders and independent mood and anxiety disorders. Objective To present nationally representative data on the prevalence and comorbidity of DSM-IV alcohol and drug use disorders and independent mood and anxiety disorders (including only those that are not substance induced and that are not due to a general medical condition). Design Face-to-face survey. Setting The United States. Participants Household and group quarters' residents. Main Outcome Measures Prevalence and associations of substance use disorders and independent mood and anxiety disorders. Results The prevalences of 12-month DSM-IV independent mood and anxiety disorders in the US population were 9.21% (95% confidence interval [CI], 8.78%-9.64%) and 11.08% (95% CI, 10.43%-11.73%), respectively. The rate of substance use disorders was 9.35% (95% CI, 8.86%-9.84%). Only a few individuals with mood or anxiety disorders were classified as having only substance-induced disorders. Associations between most substance use disorders and independent mood and anxiety disorders were positive and significant ( P Conclusions Substance use disorders and mood and anxiety disorders that develop independently of intoxication and withdrawal are among the most prevalent psychiatric disorders in the United States. Associations between most substance use disorders and independent mood and anxiety disorders were overwhelmingly positive and significant, suggesting that treatment for a comorbid mood or anxiety disorder should not be withheld from individuals with substance use disorders.

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Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

Importance National epidemiologic information from recently collected data on the newDSM-5classification of alcohol use disorder (AUD) using a reliable, valid, and uniform data source is needed. Objective To present nationally representative findings on the prevalence, correlates, psychiatric comorbidity, associated disability, and treatment ofDSM-5AUD diagnoses overall and according to severity level (mild, moderate, or severe). Design, Setting, and Participants We conducted face-to-face interviews with a representative US noninstitutionalized civilian adult (≥18 years) sample (N = 36 309) as the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III). Data were collected from April 2012 through June 2013 and analyzed in October 2014. Main Outcomes and Measures Twelve-month and lifetime prevalences of AUD. Results Twelve-month and lifetime prevalences of AUD were 13.9% and 29.1%, respectively. Prevalence was generally highest for men (17.6% and 36.0%, respectively), white (14.0% and 32.6%, respectively) and Native American (19.2% and 43.4%, respectively), respondents, and younger (26.7% and 37.0%, respectively) and previously married (11.4% and 27.1%, respectively) or never married (25.0% and 35.5%, respectively) adults. Prevalence of 12-month and lifetime severe AUD was greatest among respondents with the lowest income level (1.8% and 1.5%, respectively). Significant disability was associated with 12-month and lifetime AUD and increased with the severity of AUD. Only 19.8% of respondents with lifetime AUD were ever treated. Significant associations were found between 12-month and lifetime AUD and other substance use disorders, major depressive and bipolar I disorders, and antisocial and borderline personality disorders across all levels of AUD severity, with odds ratios ranging from 1.2 (95% CI, 1.08-1.36) to 6.4 (95% CI, 5.76-7.22). Associations between AUD and panic disorder, specific phobia, and generalized anxiety disorder were modest (odds ratios ranged from 1.2 (95% CI, 1.01-1.43) to 1.4 (95% CI, 1.13-1.67) across most levels of AUD severity. Conclusions and Relevance Alcohol use disorder defined byDSM-5criteria is a highly prevalent, highly comorbid, disabling disorder that often goes untreated in the United States. The NESARC-III data indicate an urgent need to educate the public and policy makers about AUD and its treatment alternatives, to destigmatize the disorder, and to encourage those who cannot reduce their alcohol consumption on their own, despite substantial harm to themselves and others, to seek treatment.

/pdf/epidemiology-of-dsm-5-alcohol-use-disorder-results-from-the-d5i9jx0rkx.pdf

Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III

Objective:To present nationally representative data on 12-month and lifetime prevalence, correlates, and comorbidity of DSM-IV major depressive disorder (MDD) among adults in the United States. Design/Setting/Participants:Face-to-face survey of more than 43000 adults aged 18 years and older residinginhouseholdsandgroupquartersintheUnitedStates. Main Outcome Measures: Prevalence and associationsofMDDwithsociodemographiccorrelatesandAxis I and II disorders. Results:Theprevalenceof12-monthandlifetimeDSM-IV MDD was 5.28% (95% confidence interval, 4.98-5.57) and 13.23% (95% confidence interval, 12.64-13.81), respectively. Being female; Native American; middleaged; widowed, separated, or divorced; and low income increased risk, and being Asian, Hispanic, or black decreased risk (P.05). Women were significantly more likely to receive treatment than men. Both current and lifetimeMDDweresignificantlyassociatedwithotherspecific psychiatric disorders, notably substance dependence, panic and generalized anxiety disorder, and several personality disorders. Conclusions:This large survey suggests a higher prevalence of MDD in the US population than large-sample estimates from the 1980s and 1990s. The shift in highest lifetime risk from young to middle-aged adults is an important transformation in the distribution of MDD in the United States and specificity in risk for an ageperiodcohort.AssociationsbetweenMDDandAxisIand II disorders were strong and significant, with variation within broad categories by specific diagnoses signaling the need for attention to the genetic and environmental reasons for such variation, as well as the implications for treatment response. Arch Gen Psychiatry. 2005;62:1097-1106

/pdf/epidemiology-of-major-depressive-disorder-results-from-the-d3vtw5sg3b.pdf

Epidemiology of Major Depressive Disorder: Results From the National Epidemiologic Survey on Alcoholism and Related Conditions

http://www.doctordeluca.com/Library/AddictionMeds/Prevalence&TrendsAlcAbuseDep90s04.pdf

The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991-1992 and 2001-2002.

The Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): Reliability of alcohol and drug modules in a clinical sample

Objective : The purpose of this study was to investigate the reliability of a new semistructured diagnostic interview, the Psychiatric Research Interview for Substance and Mental Disorders (PRISM), for substance-abusing patients. The reliability of psychiatric diagnoses for individuals who drink heavily or use drugs has been shown to be problematic. The PRISM was designed to improve the reliability for such individuals. Method : A test-retest reliability study of the PRISM was conducted with 172 patients being treated in dual-diagnosis or substance abuse settings. Results : Good to excellent reliability was shown for many diagnoses, including affective disorders, substance use disorders, eating disorders, some anxiety disorders, and psychotic symptoms. The interview has recently been updated for DSM-IV diagnoses. Conclusions: The PRISM offers a method of producing psychiatric diagnoses with improved reliability for patients and other research subjects who have problems with alcohol or drugs.

Psychiatric Research Interview for Substance and Mental Disorders (PRISM): reliability for substance abusers.

Over five hundred years ago, Copernicus presented findings that revolutionized the world by shifting focus away from the Earth and towards the sun as the center of the universe. Education has been encountering a similar paradigm-altering shift with the center of learning moving from the teacher to the learner. Learning-oriented assessment (LOA) is an emerging framework of that reconceptualization. LOA is, at its core, learner-centric, where attention falls concentrically, beginning with the learner, followed by learner interactions with other agents in the learning process, then moving to factors outside of the learner within the learning space (J. E. Purpura, personal communication, September 12, 2014).

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M. Smith

Papers

The Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): Reliability of alcohol and drug modules in a clinical sample

Psychiatric Research Interview for Substance and Mental Disorders (PRISM): reliability for substance abusers.

Learning-Oriented Assessment: The Contextual Dimension