Drinking Distilled. Onset, course and treatment of alcohol use disorders in the general population

Although most people in Western society drink alcohol and regard this to be harmless and normal, some people drink excessively and develop an alcohol use disorder. This thesis examined the onset, course and treatment of alcohol use disorders in the general population using 3-year longitudinal data from a large population-based study (NEMESIS-2), including 6,646 adults (aged 18-64). - Childhood externalizing disorders proved to be strongly related with alcohol use disorders: a pathway was observed from childhood ADHD to alcohol use disorder via childhood conduct disorder. - Most people with an alcohol use disorder had mild and transient problems: 75-80% did not drink excessively, 70% remitted spontaneously within three years and only 12% of those in remission relapsed. - Individuals with a high drinking level, a high number of alcohol use disorder criteria, and comorbid psychopathology, specifically anxiety disorders, were at risk of a chronic alcohol use disorder. - Only 10% of those with an alcohol use disorder received specialized alcohol treatment, but this process seems quite adequate with those most in need of help having the highest contact rate. To prevent alcohol use disorders, early recognition and treatment of individuals with childhood externalizing disorders appears important. Although treatment resources seem to be allocated quite efficiently, treatment access may be further improved by targeting the small group of non-treatment seekers at risk of a chronic course