Alcohol Through the Lifespan:
Current Trends in Consumption,
Treatment, and Criminal
Behavior
Mitchell Karno, Ph.D.
Presented at the 61st Semi-annual meeting of the
Association for Criminal Justice Research (California)
McClellan, California
March 18, 2005
Costs of Alcohol Abuse to the Nation - 1990
Total: $98.6 Billion
Core Medical
Expenditures:
Billion
$10.5
Other Alcohol-related Costs:
$15.8 Billion
–
–
–
–
–
–
– Specialty organizations
(33%)
– Short-stay hospitals (44%)
– Nursing homes (10%)
– Support & Other (13%)
Indirect:
$70.3 Billion
– Morbidity (52%)
– Mortality (48%)
Crime (36%)
Victims of crime (3%)
Incarceration (30%)
Motor vehicle crashes (24%)
Fire destruction (4%)
Social welfare administration
(1%)
Fetal Alcohol Syndrome:
$2.1 Billion
Rice, 1993; NIAAA, Alcohol & Health, 1997
2.6
2.4
2.2
2.0
1.8
1.6
1.4
1.2
1.0
19
35
19
40
19
45
19
50
19
55
19
60
19
65
19
70
19
75
19
80
19
85
19
90
19
95
Gallons of ethanol
Total per capita ethanol
consumption, United States,
1997
2.8
Total Per Capita Consumption
of Ethanol by State, United
States, 1997
U.S. total = 2.18
DC
1.99 or below
2.00 to 2.24
2.25 to 2.49
2.50 or over
Total Per Capita Consumption of
Ethanol among Current Drinkers
by State, United States, 1997
DC
3.99 or below
4.00 to 4.49
4.50 to 4.99
5.00 or over
Concentration of U.S. Alcohol
Consumption
100
90
80
60+
Percent of Total
70
50-59
60
50
40-49
40
30-39
30
20
18-29
10
0
2.5
5
10
20
Highest Volume
30
40
50
60
Percentile of Drinkers
70
80
90 100
Lowest Volume
Greenfield TK & Rogers JD.
J Stud Alcohol 60:78 (1999)
Hazardous U.S. Alcohol Consumption
Percent of Total
100
Wine
80
60
Spirits
40
20
Beer
0
2.5
5
10 20 30 40 50 60 70 80 90 100
Highest Volume
Percentile of Drinkers
Lowest Volume
Rogers & Greenfield,
1999
Heavy Drinking by Age, Sex, and
Race
Nonblack Females
Black Females
Nonblack Males
Black Males
20
18
16
14
Percent
12
10
8
6
4
2
0
18-29
30-44
45-64
Age
65+
Alcohol Consumption in U.S.
2002 & 2003
• About 65% of persons aged 12 or older
reported any alcohol use in past year.
• About 23% of persons aged 12 or older
reported binge drinking in past 30 days.
• About 7% of persons aged 12 or older
reported heavy drinking in past 30 days.
(SAMHSA, 2004)
Heaviest Use Is Among Young
Adults
• Rates of binge and heavy drinking peak at
age 21 (about 48% and 19%, respectively).
• Young adults in college were somewhat
more likely than their non-college
counterparts to engage in binge or heavy
drinking.
(SAMHSA, 2004)
With Age Comes Moderation?
• Among young adults 18-25, rates of binge
and heavy drinking are 42% and 15%.
• Among persons 45-49, rates of binge and
heavy drinking are 23% and 7%.
• Among persons 65 and older, rates of binge
and heavy drinking are 7% and 2%.
(SAMHSA, 2004)
How does California compare?
2001-2002
• 62% of Californians reported alcohol use in
past year.
• 45% of Californians aged 18-25 reported
binge drinking at least once in past year.
• 16% of Californians aged 18-25 reported at
least weekly binge drinking over past year.
(NIAAA, 2004)
Definition of Alcohol Abuse
• A person's maladaptive alcohol use causes clinically
important distress or impairment, as shown in a single
12-month period by one or more of the following:
– failure to carry out major obligations at work,
home, or school because of repeated alcohol use,
– repeated use of alcohol even when it is physically
dangerous to do so,
– repeated experience of legal problems, or
– continued use of alcohol despite knowing that it
has caused or worsened social or interpersonal
problems.
Definition of Alcohol Dependence
• A person's maladaptive pattern of alcohol use leads to
clinically important distress or impairment, as shown in a
single 12-month period by three or more of the following:
– tolerance;
– withdrawal;
– amount or duration of use often greater than intended;
– repeatedly trying without success to control or reduce
alcohol use;
– spending much time using alcohol, recovering from its
effects, or trying to obtain it;
– reducing or abandoning important work, social, or leisure
activities because of alcohol use; or
– continuing to use alcohol, despite knowing that it has
probably caused ongoing physical or psychological
problems.
Alcohol Abuse and Dependence
by Age, Race, & Sex
25
Nonblack Females
Black Females
Nonblack Males
Black Males
Percent
20
15
10
5
0
18-29
30-44
45-64
Age
65+
NLAES, 1991
Alcohol Abuse & Dependence
Aggregate-2001/2002
• Met criteria for diagnosis in past year:
– Abuse: 4.3%
– Dependence: 3.5%
• Met criteria for diagnosis prior to past year:
– Abuse: 16.2%
– Dependence: 10.3%
(NIAAA, 2004)
Two Worlds of Alcoholism:
Help-Seeking in 1991
• Only 10% of the U.S. adult population
currently abusing or dependent on alcohol had
received any treatment in the 12 months prior
to interview.
• Only 28% of individuals with a past diagnosis
of alcohol dependence reported ever having
any kind of alcohol treatment.
• 75% of the people who recovered from a
previous alcohol disorder did so without
having received any treatment, often termed
“natural recovery.”
Help-Seeking 2001/2002
• Pattern of low help-seeking continues.
• Among persons with recent alcohol
abuse or dependence, only 7% reported
seeking assistance in past year.
• Only 25.5% of individuals with a past
diagnosis of alcohol dependence
reported ever seeking any kind of help.
• 75% of persons with prior abuse or
dependence no longer meet criteria.
(NIAAA, 2004)
Understanding Help-Seeking Pattern
 Demographics
 Clinical Issues
 Access
Client Characteristics
Demographics: GENDER
Gender Disparities In Help-Seeking
• Women may be less likely to enter alcoholism
specialty treatment.
• Women more likely to seek care in mental
health or primary car/general medical settings.
Source: Weisner et al., 1992; Grant, 1996; Kaskutas et al., 1997; Booth et al., 2000.
NLAES=National Longitudinal Alcohol Epidemiologic Survey.
Client Characteristics
CLINICAL
•
•
•
•
Alcohol use severity
Psychiatric comorbidity
Previous treatment
Alcohol consequences
• # symptoms DSM-IV alcohol use disorder (NLAES)
• Diagnosis of alcohol disorder (NAS, NHIS)
• Social consequences of drinking (NAS 1984 F/U, RAS)
Source: Grant, 1997; Kaskutas et al, 1997; Booth et al., 2000, Hasin & Grant, 1995.
NLAES=National Longitudinal Alcohol Epidemiologic Survey, RAS=Rural Alcohol Study,
NAS=National Alcohol Survey, NHIS=National Health Interview Survey
Client Characteristics
ACCESS
• Availability:
•
•
•
•
availability in the geographic area
-tremendous variation across
U.S.
Accessibility:
travel time, driver's license, car
-longer travel times reduce
outpatient use
Affordability:
income, health plan, cost of care
-NLAES: employment
- HIP: better insurance coverage
Acceptability:
stigma
Accommodation: convenience
Source: Penchansky & Thomas, 1981; Fortney et al., 1995; Manning et al., 1996; Grant, 1997;
Booth et al., 2000; Fortney & Booth, in press. RAS=Rural Alcohol Study; NLAES=National
Longitudinal Alcohol Epidemiologic Survey; HIP=RAND Health Insurance Experiment
Rural/Urban Differences in Access
Variable
Rural
Income
$30.5k
Employment
Health Insurance (any)
Perceived Availability Tx
76%
Travel Time (minutes)
Residential Tx Center
39
Self-help Group
22
General Medical Provider
Mental Health Center
Acceptability
Self-help Group
2.0
Mental Health Counselor
Hospital Treatment
Stigma
Accommodation: Waiting Times
Source: Booth et al., 2000.
Urban
$36.2k
85%
25
19
1.8
Independent Predictors of Help-Seeking
Variable
Demographics
Race, Age
Female
Access
Affordability
Accessibility
Availability
Acceptability
Social Support
Clinical
Recent Alcohol Dependence
Social Consequences of Drinking
Antisocial Personality Disorder
Axis I DSM-III-R Disorder
Drug Use
Chronic Medical Problems
Prior Alcohol Treatment
* Booth et al., 2000. OR=odds ratio, listed only when p < 0.05.
OR*
0.3
22
2.2
3.3
1.7
2.1
4.4
Locations & Providers of Care:
Helping With Drinking
The Rural Alcohol Study: 40 service users
Percent
40% >= 1 Location
90
80
70
60
50
40
30
20
10
0
35% >= 1 Provider
90
55
25
52
22
17
Inp
O
E
atie utpa R
tien
nt
t
Source: Booth et al., 2000.
Sel
f
32
7
Ge
Psy
Psy
Oth
n
c
c
e
-he
era
lp
l M hiatri holog r
st
ist
edi
or
cal
S.W
.
Locations
Providers
The influence of alcohol on
morbidity and mortality: AlcoholAttributable Fractions (AAF)
AAF
Age
Causes of death directly attributable to alcohol
1.0
>15
Diseases indirectly attributable to alcohol
Cancer of the esophagus
Acute pancreatitis
0.75
0.42
> 35
> 35
Injuries and adverse effects indirectly attributable to alcohol
Motor vehicle traffic and non-traffic deaths
0.42
Suicide and self-inflicted injury
0.28
Homicide and injury purposefully
>0
> 15
inflicted by others
0.46
> 15
Source: Stinson, F.S., and DeBakey, S.F., Alcohol-related mortality in the United States, 1979-1988, Brit. J.
Addict. 87:777-783, 1992.
Alcohol & Criminal Behavior
Drunk 51 or more days in
past year
In past year arrested for: YES (1,023) NO (23,482)
Larceny or theft
1.8%
0.2%
Burglary or breaking & 1.2
entering
Drunkenness or liquor 4.0
law violation
Aggravated assault
0.9
0.1
Other assault
0.3
3.3
(Health and Human Services NHSDA, 1997)
0.1
0.1
Alcohol & Workplace Violence
• 1/3rd of victims of workplace violence
between 1993 & 1999 believed the
perpetrator was under the influence of
alcohol or drugs at the time of the crime
(Bureau of Justice Statistics, 2001).
Alcohol & Domestic Violence
• Perpetrator problem drinking has been
associated with an 8-fold increase in
intimate partner violence. (Walton-Moss et
al., 2002)
Alcohol & Youth Violence
• Youth aged 12 to 17 who reported violent
behaviors at school or at work reported high rates
of past year alcohol use compared with youths
who did not report violent behavior. (National
Clearinghouse for Alcohol and Drug Information,
2002).
• Alcohol has been implicated in 46 to 75 percent of
the reported acquaintance rapes among 15-to-24year-olds. (National Center on Addiction &
Substance Abuse, 1999).
Summary
• Alcohol consumption nationwide has remained
relatively stable over the past several years.
• Patterns of consumption in California are similar
to that seen nationwide.
• Binge and Heavy use peak among young adults,
and then steadily decline with age.
• Relatively few persons seek help for alcohol use
problems.
• Alcohol use is associated with increases in a wide
variety of criminal activity.