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August 18, 2017

Researchers push back on idea alcohol is next 'public health crisis'

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    Some researchers are pushing back against a recent study in JAMA Psychiatry that found the percentage of alcohol use disorders in the United States increased by more than 49 percent between 2001-2002 and 2012-2013, German Lopez writes for Vox.

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    About the study

    For the study, researchers from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the New York State Psychiatric Institute reviewed face-to-face interviews of U.S. adults conducted between April 2001 to June 2002 and April 2012 to June 2013 for the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The researchers found between 2001-2002 and 2012-2013:

    • 12-month alcohol use increased from 65.4 to 72.7 percent;
    • Alcohol use disorder increased by 49.4 percent from 8.5 to 12.7 percent; and
    • High-risk drinking increased 29.9 percent from 9.7 to 12.6 percent.

    The researchers wrote that the "substantial increases in alcohol use … constitute a public health crisis" and are "alarming."

    Other experts push back

    But some experts not affiliated with the study argue that NESARC underwent significant changes to its methodology between 2001-2002 and 2012-2013. According to Vox, this means the study's findings could be attributed to differences in how the survey was conducted.

    For instance, according to Vox, NESARC changed some of the questions between the 2001-2001 and 2012-2013 surveys, and in the latter survey, respondents were asked to provide saliva samples—two changes that could have prompted people to respond differently.

    In addition, in the 2012-2013 survey respondents were given a monetary reward, which could have incentivized different populations to respond, Vox reports.

    Another discrepancy s that the 2001-2002 survey was conducted by Census Bureau workers, while the 2012-2013 survey was conducted by private workers. Richard Grucza, an alcohol researcher at the Washington University School of Medicine, said, "Some researchers speculate that using government employees might suppress reporting of socially undesirable behaviors."

    According to Vox, experts from the Substance Abuse and Mental Health Services Administration (SAMHSA) in an email said they "would strongly caution against using two points in time as an indicator in trend, especially when the data for these two points in time were collected using very different methods and do not appear to be comparable." They added, "We would encourage the consideration of data from multiple sources and more than two time points, in order to paint a more complete and accurate portrayal of substance use and substance use disorder in the nation."

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    Some experts also note that the study's findings contradict another major federal survey, called the National Survey on Drug Use and Health (NSDUH), which found alcohol use disorders among U.S. residents age 12 and older fell from 7.7 percent in 2002 to 6.6 percent in 2013, Vox reports. According to Vox, even after isolating the data for U.S. residents ages 18 years and older, as the NESARC study did, the rates of alcohol use disorder still do not rise.

    Grucza, who has studied both the NESARC and NSDUH's methodologies, said that NSDUH generally is better suited to measure trends. "The NSDUH methods are much more consistent from year-to-year, and it is administered annually," adding, "So I tend to put more weight on NSDUH data."

    According to Vox, Bridget Grant, lead author of the NESARC survey, initially said there were no changes to NESARC's methodology between the 2001-2002 survey and the 2012-2013 survey. She later confirmed that the survey's methodology was altered, but said that there is no evidence that the changes would have affected the findings.

    A muddy picture remains

    CDC data do show the number of alcohol-related deaths rose between 2001 and 2015. However, according to Vox, based on the current data it is "hard to say if a massive increase in alcohol use disorder is behind the negative trends—because the evidence for that just isn't reliable" (Lopez, Vox, 8/16).

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