Alcohol use disorder, or AUD, is the medical diagnosis for problem drinking that causes mild to severe distress or harm. A new study supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, reports that nearly one-third of adults in the United States have an AUD at some time in their lives, but only about 20 percent seek AUD treatment. The study also reveals a significant increase in AUDs over the last decade. The new findings are reported online today in the journal JAMA Psychiatry.

“These findings underscore that alcohol problems are deeply entrenched and significantly under-treated in our society,” said NIAAA Director George F. Koob, Ph.D. “The new data should provide further impetus for scientists, clinicians, and policy makers to bring AUD treatment into the mainstream of medical practice.”

A team of researchers led by Bridget F. Grant, Ph.D., Ph.D., of the NIAAA Division of Biometry and Epidemiology, conducted more than 36,000 face-to-face interviews of U.S. adults, as part of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III). NESARC III is a continuation of the largest study ever conducted on the co-occurrence of alcohol use, drug use, and related psychiatric conditions. The original NESARC survey was conducted in 2001-2002.

In NESARC III, researchers assessed alcohol problems using diagnostic criteria set forth in the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM–5) in 2013. To allow direct comparisons with previous NESARC surveys, the researchers also assessed NESARC III participants using the previous DSM-IV diagnostic criteria. Although there is considerable overlap between DSM–5 and DSM–IV diagnostic criteria, there are several important differences. For example, while DSM–IV described two distinct disorders, alcohol abuse and alcohol dependence, with specific criteria for each, DSM–5 integrates alcohol abuse and alcohol dependence into a single disorder called alcohol use disorder with mild, moderate, and severe sub-classifications.

“We found that 13.9 percent of adults met DSM-5 AUD criteria for the previous year, while 29.1 percent met AUD criteria at some time in their life,” said Dr. Grant. “Only 19.8 percent of adults with lifetime alcohol use disorder sought treatment or help, while 7.7 percent of those with a 12-month alcohol use disorder sought treatment. Perhaps most importantly, we saw large increases in DSM-IV alcohol use disorder rates over the last decade.”

Past-year and lifetime DSM-IV AUD rates for NESARC III participants were 12.7 percent and 43.6 percent, respectively. By comparison, NESARC participants in 2001 through 2002 reported past-year and lifetime DSM-IV rates of 8.5 percent and 30.3 percent, respectively. Dr. Grant and her colleagues suspect that the past decade increases may reflect increases in heavy alcohol consumption during that period, but note the need for additional research on that question.

The researchers found that rates of AUD were greater among men than women, and that age was inversely related to past-year AUD diagnosis. Among adults between ages 18 and 29, more than 7 percent had an AUD within the past year, suggesting a need for more effective prevention and intervention efforts among young people. More broadly, the researchers note the urgent need for efforts aimed at educating the public about AUD and its treatment, as well as destigmatizing the disorder.

Alcohol Use Disorder

Problem drinking that becomes severe is given the medical diagnosis of “alcohol use disorder” or AUD. Approximately 7.2 percent or 17 million adults in the United States ages 18 and older had an AUD in 2012. This includes 11.2 million men and 5.7 million women. Adolescents can be diagnosed with an AUD as well, and in 2012, an estimated 855,000 adolescents ages 12–17 had an AUD.

To be diagnosed with an AUD, individuals must meet certain criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Under DSM–5, the current version of the DSM, anyone meeting any two of the 11 criteria during the same 12-month period receives a diagnosis of AUD. The severity of an AUD—mild, moderate, or severe—is based on the number of criteria met.

To assess whether you or loved one may have an AUD, here are some questions to ask.  In the past year, have you:

• Had times when you ended up drinking more, or longer than you intended?
• More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
• Spent a lot of time drinking? Or being sick or getting over the aftereffects?
• Experienced craving — a strong need, or urge, to drink?
• Found that drinking — or being sick from drinking — often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
• Continued to drink even though it was causing trouble with your family or friends?
• Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
• More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
• Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
• Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
• Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?

If you have any of these symptoms, your drinking may already be a cause for concern. The more symptoms you have, the more urgent the need for change. A health professional can conduct a formal assessment of your symptoms to see if an alcohol use disorder is present.

However severe the problem may seem, most people with an alcohol use disorder can benefit from treatment. Unfortunately, only of a fraction of people who could benefit from treatment receive help. In 2012, for example, 1.4 million adults received treatment for an AUD at a specialized facility (8.4 percent of adults in need). This included 416,000 women (7.3 percent of women in need) and 1.0 million men (8.9 percent of men in need). Ultimately, receiving treatment can improve an individual’s chances of success in overcoming an AUD. Talk with your doctor to determine the best course of action for you and see Rethinking Drinking and Treatment for Alcohol Problems: Finding and Getting Help for more information.