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Toward a comprehensive picture of the epidemiology of alcohol and illicit drug use disorders: Novel analyses of the World Health Organization’s World Mental Health Surveys

image - World Coloured Square
Date Commenced:
November 2014
Expected Date of Completion:
March 2018
Project Supporters:

NHMRC project grant (no. 1081984)

Project Members: 
image - Chrianna Bharat
Postdoctoral Research Fellow
Project Main Description: 

In this study, we will undertake detailed analyses of the largest cross-national epidemiologic study of mental and substance use disorders ever conducted. The WHO World Mental Health Survey (WMHS) initiative is a massive, unique endeavour. It contains data on around 160,000 participants from 31 countries. Samples are epidemiological surveys in: 16 countries classified by the World Bank as high income (Argentina, Australia, Belgium, France, Germany, Israel, Italy, Japan, Netherlands, New Zealand, Northern Ireland, Poland, Portugal, Saudi Arabia, Spain, United States); 7 classified as upper-middle income (São Paulo in Brazil, Bulgaria, Medellin (Columbia), Lebanon, Mexico, Romania, South Africa); and 8 classified as lower-middle income (Beijing, Shanghai and Shenzhen in the Peoples’ Republic of China, Columbia, Iraq, Nigeria, Peru, Ukraine). These countries vary substantially in many other ways including culture, religiosity and gender roles.

Project Collaborators: External: 

Ronald Kessler, PhD
Harvard University School of Medicine, United States

Substance Use Workgroup:

Meyer Glantz, PhD
National Institute on Drug Abuse, United States

Maria Elena Medina-Mora, PhD
National Institute of Psychiatry, Mexico

Dan Stein, MD
University of Stellenbosch, South Africa

Jacek Moskalewicz, PhD
Institute of Psychiatry and Neurology, Poland

Elie Karam, MD
St George Hospital University Medical Centre, Lebanon

Laura Andrade, MD, PhD
University of Sao Paulo, Brazil

Yolanda Torres de Galvis, MPH
Centro de Excelencia en Investigación en Salud Mental, Universidad CES, Colombia

J. Elisabeth Wells, PhD
Department of Public Health and General Practice, University of Otago, New Zealand


Alcohol and illicit drug use are among the biggest risk factors for burden of disease. They caused around 5 million deaths globally in 2010, and were responsible for more than 161 million years of life lost due to disability or premature death, equating to 5% of total global health burden. In Australia, 88% of people have consumed alcohol, and 35% illicit drugs. One in four adults - almost 4 million Australians - have a history of harmful use or dependence upon these substances (“substance use disorders” (SUDs) as defined by the World Health Organization (WHO)). The impact of such widespread exposure to substance use is immense. In 2004/5 alone, the social costs to Australian society of alcohol and illicit drugs were estimated at $24.6 billion. 

Despite this, there are substantial gaps in epidemiological data on this issue. No study has charted the entire natural history of substance use and substance use disorders across the life-span, including critical transitions such as the onset of substance use, the speed of transition from use to disorder, and the probability of remission from SUDs. Prospective studies that examine prognosis of SUDs have typically been based on people seeking treatment for their substance use, or entering the criminal justice system. The natural history of substance use and SUD in these people probably differs from those who do not come to the attention of treatment services or police. There has also been little examination of whether the natural history of substance use and SUDs is consistent across countries and cultures, since most studies have been in relatively homogenous, high income countries. Finally, although work has examined which risk factors individually increase the probability of experiencing SUDs, there has been little work examining an optimal composite risk score to predict those at greatest risk of SUDs. Such scores will guide early intervention efforts.


We aim to:

  1. Estimate the incidence, prevalence, persistence and remission of alcohol and illicit substance use (cannabis, cocaine, amphetamines and opioids) and use disorders across 31 countries;
  2. Examine patterns and predictors of transitions from use to symptom onset, from symptom onset to substance abuse and dependence, and transition to remission, considering country-level variation;
  3. Using novel “data mining” methods, develop an algorithm to predict substance users at highest risk of developing SUDs, and further identify subgroups within those highest-risk groups who may differ in clinically meaningful ways, informing secondary prevention of SUDs.

A meeting of all WMHS collaborators was held in Boston in July 2016. Prof Degenhardt attended this meeting and Prof Degenhardt presented preliminary analysis showing cross-national prevalence alcohol use and alcohol use disorders. The substance use workgroup met on several occasions during this meeting to discuss these results and agree to the most important priorities and areas of research in substance use using the WMHS data. Based on feedback from this meeting a series of tasks and paper ideas were mapped out. Weekly international teleconferences were held to progress this work program. A small team from within the substance use workgroup attended these meetings and provided feedback on analysis and papers.

In November 2016, Miss Bharat, a new analyst to the project, also undertook training in the use of the WMHS data at Harvard Medical School with the aim of extending the analysis cross-nationally.

  1. Degenhardt L, Bharat C, Glantz MD, Sampson NA, Scott K, Lim CCW, et al. The epidemiology of drug use disorders cross-nationally: Findings from the WHO's World Mental Health Surveys. The International Journal on Drug Policy. 2019;71:103-12.
  2. Degenhardt L, Bharat C, Glantz MD, Sampson NA, Al-Hamzawi A, Alonso J, et al. Association of Cohort and Individual Substance Use With Risk of Transitioning to Drug Use, Drug Use Disorder, and Remission From Disorder: Findings From the World Mental Health Surveys. JAMA Psychiatry. 2019.
  3. Degenhardt L, Bharat C, Bruno R, Glantz MD, Sampson NA, Lago L, et al. Concordance between the diagnostic guidelines for alcohol and cannabis use disorders in the draft ICD-11 and other classification systems: analysis of data from the WHO's World Mental Health Surveys. Addiction. 2019;114(3):534-52.
  4. Rapsey CM, Wells JE, Bharat MC, Glantz M, Kessler RC, Scott KM. Transitions Through Stages of Alcohol Use, Use Disorder and Remission: Findings from Te Rau Hinengaro, The New Zealand Mental Health Survey. Alcohol and Alcoholism. 2019;54(1):87-96.
  5. Husky MM, Bharat C, Lepine JP, Kovess-Masfety V. Cohort Alcohol Use in France and the Transition from Use to Alcohol Use Disorder and Remission. Journal of Psychoactive Drugs. 2019:1-10.
  6. Harris MG, Bharat C, Glantz MD, Sampson NA, Al-Hamzawi A, Alonso J, et al. Cross-national patterns of substance use disorder treatment and associations with mental disorder comorbidity in the WHO World Mental Health Surveys. Addiction. 2019;114(8):1446-59.
  7. Bunting B, Bharat C. Alcohol use, regular use, disorder and remission from use disorders in Northern Ireland: a prevalence study. Addiction Research & Theory. 2019;27(4):347-53.
  8. Husky MM, Bharat C, Vilagut G, Salmeron D, Martinez S, Navarro C, et al. Birth-sex cohort alcohol use transitions in the general population: the cross-sectional PEGASUS-Murcia project. Adicciones. 2018;0(0):1067.
  9. Harker Burnhams N, Bharat C, Williams DR, Stein DJ, Myers B. Transitions between lifetime alcohol use, regular use and remission: Results from the 2004 South African Stress and Health Survey. South African Medical Journal. 2018;109(1):40-6.
  10. Glantz MD, Moskalewicz J, Caldas-de-Almeida JM, Degenhardt L. Alcohol-Use Disorders. In: Stein DJ, Scott KM, de Jonge P, Kessler RC, editors. Mental Disorders Around the World: Facts and Figures from the WHO World Mental Health Surveys. Cambridge: Cambridge University Press; 2018. p. 223-42.
  11. Degenhardt L, Glantz M, Bharat C, Peacock A, Lago L, Sampson N, et al. The impact of cohort substance use upon likelihood of transitioning through stages of alcohol and cannabis use and use disorder: Findings from the Australian National Survey on Mental Health and Wellbeing. Drug and Alcohol Review. 2018;37(4):546-56.
  12. Thornicroft G, Chatterji S, Evans-Lacko S, Gruber M, Sampson N, Aguilar-Gaxiola S, et al. Undertreatment of people with major depressive disorder in 21 countries. The British Journal of Psychiatry. 2017;210(2):119-24.
  13. Navarro-Mateu F, Alonso J, Lim CCW, Saha S, Aguilar-Gaxiola S, Al-Hamzawi A, et al. The association between psychotic experiences and disability: results from the WHO World Mental Health Surveys. Acta Psychiatrica Scandinavica. 2017;136(1):74-84.
  14. Lago L, Glantz MD, Kessler RC, Sampson NA, Al-Hamzawi A, Florescu S, et al. Substance dependence among those without symptoms of substance abuse in the World Mental Health Survey. International Journal of Methods in Psychiatric Research. 2017;26(3).
  15. Koenen KC, Ratanatharathorn A, Ng L, McLaughlin KA, Bromet EJ, Stein DJ, et al. Posttraumatic stress disorder in the World Mental Health Surveys. Psychological Medicine. 2017;47(13):2260-74.
  16. Kessler RC, Aguilar-Gaxiola S, Alonso J, Benjet C, Bromet EJ, Cardoso G, et al. Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology. 2017;8(sup5):1353383.
  17. Degenhardt L, Glantz M, Evans-Lacko S, Sadikova E, Sampson N, Thornicroft G, et al. Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health Surveys. World Psychiatry. 2017;16(3):299-307.
  18. Bromet EJ, Nock MK, Saha S, Lim CCW, Aguilar-Gaxiola S, Al-Hamzawi A, et al. Association Between Psychotic Experiences and Subsequent Suicidal Thoughts and Behaviors: A Cross-National Analysis From the World Health Organization World Mental Health Surveys. JAMA Psychiatry. 2017;74(11):1136-44.
  19. Slade T, Chiu WT, Glantz M, Kessler RC, Lago L, Sampson N, et al. A Cross-National Examination of Differences in Classification of Lifetime Alcohol Use Disorder Between DSM-IV and DSM-5: Findings from the World Mental Health Survey. Alcoholism, Clinical and Experimental research. 2016;40(8):1728-36.
  20. Lago L, Bruno R, Degenhardt L. Concordance of ICD-11 and DSM-5 definitions of alcohol and cannabis use disorders: a population survey. The Lancet Psychiatry. 2016;3(7):673-84.
  21. Degenhardt L, Chiu W-T, Sampson N, Kessler RC, Anthony JC, Angermeyer M, et al. Toward a global view of alcohol, tobacco, cannabis, and cocaine use: findings from the WHO World Mental Health Surveys. PLoS Medicine. 2008;5(7):e141.
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