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Article Excerpt
Alcohol consumption alone accounts for 9% of the total burden of illness in Mexico (Gonzalez-Pier, Gutierrez, Stevens, et al., 2006). According to new estimates from the World Health Organization (WHO) for the year 2002, alcohol was responsible for 18.7% of all years of life lost among males and 3.3% among females. The proportion of alcohol-attributable deaths in Mexico was 15.3% among men and 2.4% among women, which was higher for men than in similar areas in the American region (Rehm, Patra, Balivnas, Popova, Roerecke & Taylor 2006). Cirrhosis of the liver and unintentional injuries were the two leading causes attributable to alcohol for both males and females in 2002. In fact, death rates from cirrhosis are among the highest in the world (Edwards, Anderson, Babor, et al. 1994).
The current levels of alcohol use and alcohol-related problems are far from stable. Per capita consumption for people aged 15 and over was 3.8 litres in 1970, rising to 6.5 litres in 2004 (including 1.8 litres of unrecorded consumption) (Rehm, et al. 2006). National surveys have documented an increasingly early age of onset for excessive drinking, together with women's growing participation in alcohol consumption. The consumption of large quantities of alcohol per consumption occasion, and alcohol abuse and binge drinking in adolescents, have increased recently (Medina-Mora, Borges, Lara, Benjet, Blanco, et al. 2004). Binge drinking is frequent in Mexico (Medina-Mora, Ortiz & Carreno 2000), and the number of admissions to emergency rooms with self-reported alcohol consumption is high when compared to other countries (Borges, Cherpitel, Orozco, Bond, et al. 2006). Positive levels of alcohol in the blood are also high among emergency room patients, ranging from 20% to 30% for traumatic events (Borges, Mondragon, Cherpitl, Ye & Rosovsky 2003), which is greater than rates reported in the United States (Cherpitel, Pares, Rodes & Rosovsky 1993). Even though heavy alcohol consumption is frequent and its consequences common, we know very little about its prevalence and the types of treatment available to persons with alcohol use disorders in Mexico (Berenzon, Medina-Mora & Lara 2003).
This article extends our prior knowledge on alcohol use and alcohol use disorders from specific populations in Mexico to a nationally representative household sample. Our research used a fully structured psychiatric interview to determine the prevalence of alcohol use, alcohol use disorders and risk factors for these disorders. Most important, we report for the first time on the patterns and determinants of services utilization for alcohol use disorders in a national sample of the urban population 12 to 65 years of age.
Materials and Methods
Sample
A description of the Mexican National Comorbidity Survey (M-NCS; in Spanish, the Encuesta Nacional de Epidemiologia Psiquiatrica) has been previously reported (Medina-Mora, Borges et al. 2004). Briefly, the M-NCS was based on a stratified, multistage probability sample of non-institutionalized persons aged 18 to 65 living in urban areas of Mexico. Areas with more than 2,500 inhabitants are considered urban, and about 75% of the Mexican population lives in such areas. The fieldwork was conducted by the survey firm Berumen and Associates, whose lay interviewers were extensively trained by professionals with broad experience in supervising and conducting household surveys. Data collection took place in two phases from September 2001 through May 2002, with a total of 5,826 completed interviews. The response rate was 76.6%. Direct refusals were infrequent (6.2% of listed individuals).
The sample provided information for Mexico as a whole and for six geographic areas of the country. The six areas were (1) the three largest metropolitan areas of the country, (2) the Northwest, (3) the Northeast, (4) the Central West, (5) the Central East, (6) the Southeast. The three largest metropolitan areas are Mexico City; Guadalajara, Jalisco; and Monterrey, Nuevo Leon. The Northwest includes the states of Baja California, Baja California Sur, Nayarit, Sinaloa and Sonora. The Northeast consists of the states of Chihuahua, Coahuila, Durango, Nuevo Leon (excluding the city of Monterrey), San Luis Potosi, Tamaulipas and Zacatecas. The Central West region includes the states of Aguascalientes, Colima, Guanajuato, Jalisco (excluding the city of Guadalajara) and Michoacan. The Central East region includes the states of Guerrero, Hidalgo, Mexico (excluding the counties, or municipios, that are part of the Mexico City Metropolitan Area), Morelos, Puebla, Queretaro and Tlaxcala. The Southeast consists of the states of Campeche, Chiapas, Oaxaca, Quintana Roo, Tabasco, Veracruz and Yucatan.
Diagnostic assessment
The instrument used was the World Mental Health Survey version of the Composite International Diagnostic Interview, or CIDI (Kessler & Ustun 2004; World Health Organization 2000), a structured diagnostic interview, installed on a laptop computer and administered face to face. The CIDI provides diagnoses according to the criteria of the International Statistical Classification of Diseases and Related Health Problems, 10th revision (American Psychiatric Association 1994; World Health Organization 2001). This article reports on the diagnoses for alcohol use disorders according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Alcohol use data reported here include lifetime use, 12-month use and quantity and frequency of usual drinking in past 12 months. We also report on high-risk drinking, defined as more than two standard drinks of alcohol for women and more than four standard drinks for men on average (Ezzati 2004). Visual aids were included to help participants determine the number of drinks consumed.
Adequate interrater reliability (Cottler, Robins, Grant, et al. 1991; Wittchen, Robins, Cutler, Sartorius, Burke & Regier 1991), test-retest reliability (Wacker, Battegay, Mullejans & Schlesser 1990) and validity (Farmer, Katz, McGuffin & Bebbington 1987; Janca, Robins, Cottler & Early 1992) of earlier CIDI versions have been documented (Andrews and Peters 1998; Caraveo, Gonzalez & Ramos 1991). The translation of the instrument into Spanish was carried out by an international expert panel that was convened by the WHO. The panel members, who were mental health experts qualified as clinicians and researchers, were from Chile, Colombia, Mexico, Panama, Spain and the United States (including Puerto Rico). The...
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