NDARC Technical Report No. 97 (2000)
In 1997, the Australian Bureau of Statistics (ABS) conducted the National Survey of Mental Health and Well-Being (NSMHWB), the first population survey of the prevalence of alcohol use disorders (alcohol abuse and dependence) in the Australian population. This technical report presents the overall findings from the survey on the prevalence, and correlates of alcohol use disorders, rates of covariance with other mental disorders and substance use disorders (comorbidity), and the prevalence of alcohol dependence symptoms in the Australian population.
The present report examined the prevalence and correlates of alcohol use, DSM-IV alcohol abuse, and DSM-IV alcohol dependence within the past 12 months in the Australian population. It examined patterns of comorbidity between alcohol use and other substance use problems, and other mental health problems. Multivariate analyses were conducted to examine whether any observed associations remained after controlling for demographics, neuroticism and other substance use. Analyses were also conducted of the symptoms of alcohol dependence reported in the general population. The level of agreement between ICD-10 and DSM-IV diagnostic systems was also calculated.
Men were more likely than women to report drinking, meet criteria for alcohol abuse and for alcohol dependence. There was a pronounced age-related pattern of involvement with alcohol, with the youngest age group (those aged 18-24 years) most likely to meet criteria for alcohol abuse (5.2%) and for dependence (9.3%). Those who were married or in a defacto relationship were more likely to report drinking but less likely to report problematic drinking than those who had never been married, or who were separated or divorced. Those who were unemployed were most likely to meet criteria for alcohol abuse or dependence.
Alcohol use was strongly related to the use of other drug types. Those who did not report alcohol use within the past 12 months were least likely to report using tobacco, cannabis, sedatives, stimulants or opiates. As the level of involvement with alcohol increased, so too did the prevalence of other drug use and other drug use disorders. Half (51%) of those who were alcohol dependent were regular smokers, one third had used cannabis (32%), and 15% reported other drug use; 15% met criteria for a cannabis use disorder and 7% met criteria for another drug use disorder. In comparison, 15% of non-drinkers were regular smokers, 2% reported cannabis use in the past year, 3% reported other drug use. Less than one per cent of non-drinkers met criteria for a cannabis or other drug use disorder.
Persons who met criteria for alcohol dependence were most likely to also meet criteria for an anxiety (20%) or an affective (24%) disorder. Those who were non-drinkers were more likely to meet criteria for anxiety and affective disorders than non-problematic drinkers (anxiety 6.5% vs. 4.5%; affective 7.3% vs. 5.5%). On symptom measures of mental health and well-being, those who were alcohol dependent reported the poorest levels of mental health, and non-drinkers reported poorer mental health than non-problematic drinkers.
The most commonly reported symptoms of DSM-IV alcohol dependence in the Australian population were using for longer than intended or in larger amounts than intended (15% of drinkers), persistent desire for alcohol use (12%) and tolerance to the effects of alcohol (10%). Large proportions of male drinkers reported dependence symptoms, and the criteria discriminated well between dependent and non-dependent drinkers. Analyses suggested that the DSM-IV criteria formed a unidimensional syndrome of severity.
There was good agreement between ICD-10 and DSM-IV diagnostic systems in which persons received a dependence diagnosis. There was almost no agreement between the diagnosis of alcohol abuse in DSM-IV and harmful use in ICD-10, suggesting that the two systems identify different persons reporting problems from their alcohol use.
Alcohol use disorders are among the most prevalent disorders in the community. They are most likely to occur among males aged 18 to 24 years. They are also associated with higher rates of other substance use problems and other mental health problems than occur among persons without alcohol use disorders. Very few persons with these disorders seek or receive treatment. This does not necessarily indicate that these disorders are grossly under-treated since many will remit without specialist help. Public education about the risks of alcohol use may be the best way to target the prevalent, milder forms of alcohol disorders. Self-help strategies for quitting or cutting down may remove the need for professional help in those coming to attention in primary health care. For more severe cases whose problems resist self-help, existing treatment systems need to provide more effective forms of treatment, more efficiently. Better triage would ensure a more rational use of scarce treatment resources.