ADC 510 Module 1 Epidemiology of Substance Use Example

How Many and Who: Using National Epidemiology to Estimate Need in One Ohio County

Student Name

Psychology and Addiction Studies Program, Aspen University

ADC 510: Addiction Theories and Practice

Instructor Name

Month Day, Year

How Many and Who: Using National Epidemiology to Estimate Need in One Ohio County

Priya, enrolled in Aspen University's graduate addiction program, is completing her internship with the mental health and recovery board that funds services in a rural southern Ohio county. The county, the board and its staff are invented for this course. Her supervisor wants a figure for the grant narrative: roughly how many county adults might need help with alcohol or drugs, to justify a new outpatient program. This paper reviews the epidemiological evidence and uses it to build the estimate.

Key Terms

Epidemiology studies how often conditions occur in populations and why. Prevalence tells us what share of people have a condition, measured on one day or across a span such as twelve months or a whole life. Incidence counts how fast fresh cases appear. Burden combines the deaths and disability a condition causes, often measured in disability-adjusted life years. A distinction runs through all substance use epidemiology: using a substance is not the same as having a substance use disorder. Most drinkers never meet criteria for a disorder, and many people who experiment with illicit drugs stop on their own.

The Global Picture

Degenhardt and Hall (2012) reviewed evidence on illicit drug use and dependence worldwide. They estimated that a substantial minority of the world's adults had used an illicit drug in the past year, with cannabis by far the most common, and that a much smaller number used drugs in problematic or dependent ways. Opioid dependence accounted for the largest share of the burden of disease attributable to illicit drugs, through overdose, infectious disease and other harms. Use and harm were highest in high-income countries, including the United States, though data from many low- and middle-income countries were sparse. The review showed that the harms of drug use are concentrated among a relatively small group of people who use drugs heavily.

The National Picture

Grant et al. (2015) analyzed the 2012-2013 round of NESARC, which interviewed tens of thousands of American adults face to face, to estimate how many met the current diagnostic criteria for alcohol use disorder. They found that about 14 percent of adults met criteria in the past year and about 29 percent at some point in their lives. Most cases were mild, but the disorder was associated with other mental disorders and disability. Only about one in five people with a lifetime alcohol use disorder had ever received treatment.

Grant et al. (2016) used the same survey to study drug use disorders. About 4 percent of adults met criteria in the past year and about 10 percent in their lifetime. Drug use disorders were associated with substantial disability and with other mental disorders. Only about one in seven people with a lifetime drug use disorder had ever been treated.

A County Estimate

The county has about 62,000 adults. Applying national past-year rates gives a first estimate.

The two past-year figures overlap, since some people have both disorders, so they cannot simply be added.

Who Is Most Affected

National surveys also show that disorders are not spread evenly. Grant and colleagues found that both alcohol and drug use disorders were more common among men, younger adults and people who had never married, and that drug use disorders in particular were associated with lower income and with other mental health conditions. These patterns matter for planning: a program that serves mainly older adults or that requires daytime attendance may miss the people most likely to need it. Priya noted that the county's young adults, many working irregular shifts, would need evening and weekend services.

Why the County May Differ

National rates are a starting point, not an answer. The county differs from the nation in ways that matter. It is rural, with lower average income and higher unemployment, and has been heavily affected by the opioid epidemic; its overdose death rate has exceeded the state average for several years. Degenhardt and Hall's finding that opioid dependence drives much of the burden suggests that drug use disorders, and their consequences, may be more common here than national averages imply. On the other hand, alcohol use disorder rates vary with drinking patterns and age structure in ways national figures cannot capture. Treatment rates may also be lower than national figures suggest, given that the county has one outpatient program and no medication-assisted treatment provider within forty miles.

What the Estimate Means for the Grant

Even with its uncertainties, the estimate makes the case clearly. If roughly six thousand county adults have had a drug use disorder and most have never been treated, a single outpatient program with fewer than two hundred places cannot meet the need. The estimate also shapes what the new program should offer: given the county's opioid burden, medication for opioid use disorder; given the untreated majority, outreach and low-barrier entry rather than waiting lists.

Checking the Estimate With Local Data

Priya recommended three local sources to test the estimate. State treatment admission records would show how many county residents enter treatment each year. Emergency department visits and overdose deaths would indicate the scale of severe harm. And the state's youth survey would give a picture of early use. Comparing these with the national estimate would show whether the county's need is larger or smaller than national rates imply.

Conclusion

Global evidence from Degenhardt and Hall shows that the burden of drug use falls heavily on a small group with severe problems, especially opioid dependence. National surveys by Grant and colleagues show that alcohol use disorder is common, drug use disorders less so, and that most people with either never receive treatment. Applied to Priya's county, national rates suggest thousands of adults with disorders and a large untreated majority, an estimate local data should refine.

References

Degenhardt, L., & Hall, W. (2012). Extent of illicit drug use and dependence, and their contribution to the global burden of disease. The Lancet, 379(9810), 55-70. https://doi.org/10.1016/S0140-6736(11)61138-0

Grant, B. F., Goldstein, R. B., Saha, T. D., Chou, S. P., Jung, J., Zhang, H., Pickering, R. P., Ruan, W. J., Smith, S. M., Huang, B., & Hasin, D. S. (2015). Epidemiology of DSM-5 alcohol use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry, 72(8), 757-766. https://doi.org/10.1001/jamapsychiatry.2015.0584

Grant, B. F., Saha, T. D., Ruan, W. J., Goldstein, R. B., Chou, S. P., Jung, J., Zhang, H., Smith, S. M., Pickering, R. P., Huang, B., & Hasin, D. S. (2016). Epidemiology of DSM-5 drug use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. JAMA Psychiatry, 73(1), 39-47. https://doi.org/10.1001/jamapsychiatry.2015.2132