DSM-IV alcohol use disorders in Australia: validity, prevalence and treatment seeking

Abstract

Alcohol use disorders are common and make a significant contribution to the burden of disease throughout the world. This is especially true among the younger age groups. Although these disorders are common, evidence suggests that those affected do not seek help for their disorders. In order to understand this, reviews of the treatment literature and the epidemiological data on prevalence and correlates of alcohol use disorders and treatment seeking are presented. These reviews confirm that effective treatments exist and that screening in primary care can be efficacious. The reviews also highlight deficits such as the need for more epidemiological evidence on the validity of DSM definitions of alcohol use disorders and for more Australian data on the prevalence and correlates of the disorders and related treatment seeking. This thesis sets out to address these deficits applying sophisticated statistical techniques to data from a large nationally representative Australian sample. A confirmatory factor analysis of the eleven criteria that specify alcohol dependence and abuse examined the validity of DSM-IV definitions of alcohol use disorders and the best solution was found to be a single factor, not two as currently defined. These findings question the bi-axial nature of alcohol use disorders that has underpinned their definition since the publication of DSM-III-R in 1987. Data from this national sample also confirm that, in line with research from other western countries, Australians have high levels of alcohol use disorders, especially amongst males and younger people. Also no association was found between alcohol dependence and treatment seeking, and young people were least likely to seek treatment. However, a relatively large proportion of young people who drink had been in contact with their GPs in the past year; demonstrating that there is ample opportunity for screening and referral for treatment for alcohol use disorders in this vulnerable group.

This research has found that although alcohol disorders are not necessarily associated with disability, there are those who can benefit from treatment. It suggests that outcomes for such individuals may be improved by better specification of disorders as well as improved access to best treatments.