The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)
Waves 1 and 2 and NESARC-III: summary of findings

                                                                                                                Bridget GRANT - Rockville - USA

The NESARC, a “third-generation” psychiatric epidemiologic survey that integrated detailed measures of
alcohol and drug use and problems has been the data source for over 1000 publications. This presentation
covers a review of Waves 1 and 2 NESARC and NESARC-III findings and their implications. NESARC
was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors,
and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2
follow-up re-interviews were conducted with 34,653 of the original participants.

The NESARC-III, a cross-sectional survey was conducted in 2012-2013 (n = 36,091). The most common
disorders were alcohol and posttraumatic stress disorders, and major depression. Females had
more internalizing disorders and males had more externalizing disorders, although the preponderance of
males with alcohol disorders (the “gender gap”) was less pronounced than it was in previous decades.
A race/ethnic “paradox” (lower risk among disadvantages minorities than whites) remains unexplained.
Younger participants had higher risk for substance and personality disorders, but not unipolar depressive
or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic
domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking
decreased, although smoking decreases were less pronounced among those with comorbidity.

A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between
Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders
were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism
about efficacy) were more important in predicting non-treatment than financial barriers. Understanding
comorbidity and the effects of early stressors will require research incorporating biologic components,
e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted
by attitudinal rather than financial variables, suggests an urgent need for public and professional education
to reduce the stigma associated with these disorders and increase knowledge of treatment options.