Objective: This study aims to expand on published literature regarding the transition from alcohol initiation to alcohol dependence among newly initiated alcohol users. The main aim is to broaden the estimates to include a larger age group, comparing male and female differences, and exploring potential associations that link days of drinking with the occurrence of alcohol dependence among newly initiated drinkers (NID) and individuals who are alcohol dependent. An additional goal is to assess the criteria in DSM-IV and DSM-5 regarding alcohol use disorders (AUD), thus exploring the change in the questions that the United States National Surveys on Drug Use and Health has been using to measure AUD for the survey each year. In conclusion, I propose a protocol for clinicians to use to gauge their disagreement with the DSM-5 unit-weighting of individual diagnostic criteria versus alternatives that allow clinicians to weight some criteria more heavily than others. I have included this proposed protocol in my thesis as a direction for future research. Due to the SARS-COV-2 pandemic and other circumstances, I offer the protocol, but I do not provide empirical estimates. The empirical estimates remain on the agenda for future research. Study Design: The United States National Surveys on Drug Use and Health (US, NSDUH, 2002-2019) draw samples of the nation's population, take standardized measurements, and provide the primary data for this research. The sample population included non-institutionalized U.S. civilian residents aged 12 years and older, and NSDUH seeks to produce a nationally representative sample of this segment of the U.S. population. For my thesis research project, I tapped the 'Restricted-use Data Analysis System (RDAS) online analysis tool, which organizes the datasets in year-pairs, from which analysis-weighted study estimates and variances can be derived. After deriving these estimates, I produced meta-analytic summaries with 95% confidence intervals (CI). Frequency distributions are used for the analysis-weighted estimates of the association involving days of drinking.Results: Looking across 2002-2019, the meta-analytic summary for newly initiated alcohol users who became alcohol-dependent within the first year of use is 1.67% [95% CI: (1.46, 1.95)]. For every 100 NIDU, roughly 1.5-2.0 had become dependent when assessed within the first year after the first full drink. Focusing on male and female differences, females had a modestly different meta-analytic estimate for the transition from initiation to the dependence on alcohol (1.86% [95% CI: (1.6, 2.2)] versus the corresponding male estimate of 1.47% [95% CI: (1.2, 1.8], but this female-male variation is unremarkable when the overlap of 95% CI is taken into account. The most common drinking days for all newly initiated alcohol users irrespective of alcohol dependence from 2002 to 2019 were 1-11 days (78.1%), compared to 100-299 days for all alcohol-dependent users from 2002 to 2019 (53.9%). Looking at the 2002-2020 data for the same estimates, there was not an appreciable difference in the meta-analytic summary for newly initiate alcohol users who became alcohol-dependent within the first year of use [1.69% (95% CI: (1.45, 1.91]). Adding the 2020 data to the male estimate decreased the overall meta-analytic summary to 1.34% [95% CI (1.1, 1.7). The female estimate did not change appreciably, increasing to 1.90 from 1.86% [95% CI (1.63, 2.21)]. Finally, the number of individuals with alcohol disorders increased greatly in 2020 when using DSM-5 criteria (9.9%, 95% CI (9.4, 10.6)) versus DSM-IV criteria (3.2, 95% CI (2.9, 3.5). Conclusion: The estimate of newly incident alcohol users and their subsequent transition to dependence has varied from 2002 to 2019; the aggregated meta-analytic estimate is 1.7%. Females had a higher transition rate from initiation to dependence on alcohol within the first year than males. Individuals who are alcohol dependent drank more on average than newly initiated alcohol users. Once the confidence interval overlap is taken into account, there is no basis for claiming a female or a male excess in the occurrence of alcohol dependence soon after the onset of drinking when all ages are considered. The difference between the observed estimates of 1.5% and 1.9% is negligible once variances are considered. Finally, the changes made from DSM-IV to DSM-5 resulted in an increased estimate for individuals captured using the modified criteria for diagnosis. Directions for future research include different analyses on the transition estimates and using the estimates in the changes from DSM-IV to DSM-5 in a clinical setting to intervene in more alcohol disorder cases sooner, preventing serious complications and death.
Read
