Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA.
Department of Medical Sciences, Frank H. Netter School of Medicine at Quinnipiac University, North Haven, Connecticut, USA.
Alcohol Clin Exp Res. 2022 Mar;46(3):422-433. doi: 10.1111/acer.14781.
Despite its potential to produce serious adverse outcomes, DSM-5 alcohol withdrawal syndrome (AWS) has not been widely studied in the general population.
We used cross-sectional data from 36,309 U.S. adults from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III to examine the past-year prevalence of AWS and its correlates. We focused on an important clinical population-past-year drinkers with unhealthy alcohol use-i.e., those with a positive score on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire. We also examined the association of AWS with sociodemographic measures, psychiatric disorders, alcohol-related measures, and healthcare utilization.
Approximately one-third (n = 12,634) of respondents reported unhealthy alcohol use (AUDIT-C+). Of these, 14.3% met criteria for a DSM-5 AWS diagnosis. The mean (SE) number of withdrawal symptoms among individuals with AWS was 2.83 (1.88), with the most common being nausea/vomiting and insomnia (19.8% and 11.6%, respectively). Among AUDIT-C+ respondents, the odds of AWS were significantly higher among males (adjusted odds ratio [aOR] = 1.17 [95% CI, 1.02-1.33]), unmarried participants (aOR = 1.55 [95% CI, 1.25-1.92]), and those at the lowest (vs. highest) income levels (aOR = 1.62 [95% CI, 1.37-1.92]). Among AUDIT-C+ respondents, AWS was also associated with psychiatric disorders (with aORs that ranged from 2.08 [95% CI, 1.79-2.41]) for major depressive disorder to 3.14 (95% CI, 1.79-2.41) for borderline personality disorder. AUDIT-C+ respondents with AWS also had higher odds of past-year alcohol use disorder (aOR = 11.2 [95% CI, 9.66-13.07]), other alcohol-related features (e.g., binge drinking), and healthcare utilization.
Among individuals with unhealthy alcohol use, AWS is prevalent, highly comorbid, and disabling. Given the risk of AWS among unhealthy drinkers, a comparatively large segment of the general population, clinicians should seek to identify individuals with AWS and intervene with them to prevent serious adverse outcomes.
尽管 DSM-5 酒精戒断综合征（AWS）有可能产生严重的不良后果，但它在普通人群中并没有得到广泛研究。
我们使用了来自 2012-2013 年美国全国酒精相关情况流行病学调查-III 的 36309 名美国成年人的横断面数据，研究了过去一年 AWS 的流行率及其相关因素。我们关注的是一个重要的临床人群-过去一年饮酒且存在不健康饮酒行为的人群，即酒精使用障碍识别测试-消费（AUDIT-C）问卷呈阳性的人群。我们还研究了 AWS 与社会人口学指标、精神障碍、酒精相关指标和医疗保健利用之间的关联。
大约三分之一（n=12634）的受访者报告了不健康的饮酒行为（AUDIT-C+）。其中，14.3%符合 DSM-5 AWS 诊断标准。AWS 患者的平均（SE）戒断症状数为 2.83（1.88），最常见的是恶心/呕吐和失眠（分别为 19.8%和 11.6%）。在 AUDIT-C+受访者中，AWS 的几率在男性（调整后的优势比[aOR]1.17 [95%置信区间，1.02-1.33]）、未婚参与者（aOR 1.55 [95% CI，1.25-1.92]）和收入最低（与最高收入）人群中显著更高（aOR 1.62 [95% CI，1.37-1.92]）。在 AUDIT-C+受访者中，AWS 还与精神障碍相关（心境恶劣障碍的 aOR 范围为 2.08 [95% CI，1.79-2.41]，边缘型人格障碍的 aOR 为 3.14 [95% CI，1.79-2.41]）。AWS 与过去一年酗酒障碍（aOR 11.2 [95% CI，9.66-13.07]）、其他酒精相关特征（如 binge drinking）和医疗保健利用的几率也更高。
在存在不健康饮酒行为的人群中，AWS 很普遍，且与多种疾病共病并导致残疾。鉴于 AWS 在不健康饮酒者中的风险，即普通人群中相当大的一部分，临床医生应该寻求识别患有 AWS 的个体，并对他们进行干预，以预防严重的不良后果。
