Epidemiology of DSM-5 Drug Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III.
Level 4 - case-series / case-control
Nationally representative cross-sectional survey
PubMed 26580136 · doi:10.1001/jamapsychiatry.2015.2132
What was done
Cross-sectional analysis of in-person structured diagnostic interviews from 36,309 US adults in the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; overall response rate 60.1%). The study estimated the prevalence, sociodemographic correlates, psychiatric comorbidities, disability, and treatment rates for 12-month and lifetime DSM-5 drug use disorders (DUD) covering 10 drug classes.
What was found
Prevalence of 12-month and lifetime DSM-5 DUD was 3.9% and 9.9%, respectively. DUD was higher in men, White and Native American individuals, younger and unmarried adults, lower-income/education groups, and Western US residents. Any 12-month DUD was significantly associated with major depressive disorder (OR, 1.3; 95% CI, 1.09-1.64), dysthymia (OR, 1.5; 95% CI, 1.09-2.02), bipolar I (OR, 1.5; 95% CI, 1.06-2.05), PTSD (OR, 1.6; 95% CI, 1.27-2.10), antisocial personality disorder (OR, 1.4; 95% CI, 1.11-1.75), borderline personality disorder (OR, 1.8; 95% CI, 1.41-2.24), and schizotypal personality disorder (OR, 1.5; 95% CI, 1.18-1.87). Lifetime DUD was also associated with generalized anxiety disorder (OR, 1.3; 95% CI, 1.06-1.49), panic disorder (OR, 1.3; 95% CI, 1.06-1.59), and social phobia (OR, 1.3; 95% CI, 1.09-1.64). Only 13.5% of respondents with 12-month DUD and 24.6% with lifetime DUD received treatment.
Why it matters
This study provides baseline national estimates for DSM-5 drug use disorder epidemiology in the US, highlighting substantial psychiatric comorbidity, associated disability, and a large treatment gap.
Limits
The cross-sectional design cannot establish causality or temporal ordering of comorbidities. Data rely on retrospective self-report subject to recall and social desirability biases, and the overall survey response rate was 60.1%.