Introduction to the National Epidemiologic Survey on Alcohol and Related Conditions

Bridget F. Grant, Ph.D., Ph.D., and Deborah A. Dawson, Ph.D.

Bridget F. Grant, Ph.D., Ph.D., is chief of, and Deborah A. Dawson, Ph.D., is senior clinician in the Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, at the National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland.

In 2001/2002, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) conducted the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), the largest and most ambitious comorbidity study ever conducted. In addition to an extensive battery of questions addressing present and past alcohol consumption, alcohol use disorders (AUDs), and utilization of alcohol treatment services, NESARC included similar sets of questions related to tobacco and illicit drug use (including nicotine dependence and drug use disorders). Furthermore, NESARC contained questions that operationalized the criteria set forth in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM–IV) for the following psychiatric disorders:

Five mood disorders (major depressive disorder, bipolar I and bipolar II disorders, dysthymia, and hypomania)
Four anxiety disorders (panic with and without agoraphobia, social phobia, specific phobia, and generalized anxiety)
Seven personality disorders (avoidant, dependent, obsessive–compulsive, paranoid, schizoid, histrionic, and antisocial disorders).

The unprecedented sample size of NESARC (n = 43,093) made it possible to achieve stable estimates of even rare conditions. Moreover, its oversampling of Blacks and Hispanics as well as the inclusion of Hawaii and Alaska in its sampling frame yielded enough minority respondents to make NESARC an ideal vehicle for addressing the critical issue of race and/or ethnic disparities in comorbidity and access to health care services.

NESARC’s diagnostic classifications were based on the Alcohol Use Disorder and Associated Disability Interview Schedule–DSM–IV Version (AUDADIS– IV), a state-of-the-art, semistructured diagnostic interview schedule designed for use by lay interviewers. The reliability and validity of this instrument have been documented in a wide range of international settings, using both general population and clinical samples (for an extensive list of publications on reliability and validity, see the data notes section of the NESARC Web site).

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