Alcohol and Other Drug Abuse: Changing Lives through Research and Treatment

Keynote address ALCOHOL AND OTHER DRUG ABUSE: CHANGING LIVES THROUGH RESEARCH AND TREATMENT BENY PRIMM, M.D. Associate Administrator Office for Treatment Improvement Alcohol, Drug Abuse, and Mental Health Administration Department of Health and Human Services 5515 Security Lane Rockwall II Building, Tenth Floor Rockville, MD 20857 THE THEME OF THIS CONFERENCE points to the connection between mental health and substance abuse. Anecdotally, of course, we have long known that there is a connection. Examples are all around us. Just this August, for example, a subway crashed in New York City. The result was that a number of people lost their lives and many more were injured. The transportation infrastructure suffered great damage, as well, and because of that, travel for many hundreds of thousands of people was disrupted for weeks. The police reported tentatively thatthemotorman'sblood alcohol level, when tested many hours after the accident, was double the legal limit. The motorman was said to have been severely depressed, despondent, and disoriented because of a lover's quarrel. Such direct correlations between mental health and drug abuse occur all the time, and frequently with serious consequences for society. And as physicians and health professionals, we have always known that when people are in drug treatment programs, their mental disorders become apparent. But what statistical documentation proves the linkages between mental health and drug abuse? The most comprehensive national data, in my judgment, comes from the Epidemiologic Catchment Area Studies that the National Institute of Mental Journal of Health Care for the Poor and Underserved, Vol. 3, No. 1, Summer 1992 Changing Lives through Research and Treatment Health has sponsored since 1980. These five contemporaneous area studies provide what the late philosopher Paul Lazarsfeld would call a scientific "map" that, once it is drawn, enables considerable work, for it outlines major areas requiring investigation.1 As the Archives of General Psychiatry of the American Medical Association noted in an editorial2 on the area studies, "For the United States, the program is a landmark in psychiatric epidemiology and psychiatric research generally. For the first time, mental health epidemiology is linked to ongoing biological, nosological, genetic, familial, and clinical research on mental disorders."* The Catchment Studies involve nearly 20,000 community residents in five sites who were interviewed by investigators using the Diagnostic Interview Schedule and followed up a year later with a re-interview designed to obtain data on incidence and service use. The sites were in Baltimore, New Haven, Durham, St. Louis, and Los Angeles. And, unlike anything else in the past, the Catchment Studies involved investigation of the 13 or more disorders that comprise the major psychiatric illnesses listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III)—illnesses germane to public health policymakers. We are now able to comment reliably on the scope and boundaries of mental illness. One of the very first studies of the data was entitled "Lifetime Prevalence of Specific Psychiatric Disorders in Three Sites."3 This study addressed both alcohol abuse and drug abuse as well as major depressive episodes and phobias. Using data from three of the 13 sites, the authors found that alcohol abuse or dependence affected between 11 percent and 16 percent of the population and drug abuse affected between five percent and six percent at some time in their lives. Moreover, if the substance abuse disorders were removed, rates of persons having one of the mental disorders would have dropped by about a third in two of the sites, about a fifth in the other. Differences in rate of psychiatric disorders between African-Americans and others were reported as "generally modest and rarely statistically significant ."3 A glance at the tables shows that while the prevalence of alcohol use or dependence of African-Americans ran close to that of whites, the incidence of drug abuse was somewhat higher, especially in the Baltimore Catchment Area, the one site with a high population density of African-Americans. A follow-up study, "One-Month Prevalence of Mental Disorders in the United States," extended these findings.4 Here, researchers found that the most current (within one month) specific disorders were phobia, dysthymia (morbid anxiety and depression), and alcohol abuse or dependence. Substance...