Socio-economic status and problem alcohol use: the positive relationship between income and the DSM-IV alcohol abuse diagnosis.

AIMS: Epidemiological evidence indicates a positive relationship between income and the prevalence of alcohol abuse in the general population, but an inverse relationship between income and alcohol dependence. Among those with a diagnosis of alcohol abuse, the most prevalent criterion is hazardous use, which commonly requires sufficient resources to own or access a car. The present study investigated whether the association between income and the prevalence of current alcohol abuse is accounted for by the hazardous use criterion; specifically, the drinking and driving symptoms of the hazardous use criterion.

DESIGN: Face-to-face survey conducted in the 2001-02 National Epidemiologic Survey on Alcohol and Related Conditions, interviewed with the Alcohol Use Disorders and Associated Disabilities Interview 4th edition (AUDADIS-IV).

SETTING: The United States and District of Columbia, including Alaska and Hawaii.

PARTICIPANTS: Household and group-quarters residents aged >18 years. Life-time dependence cases were excluded (n = 4781).

MEASUREMENTS: Income was defined as past-year personal income. Outcomes were specific alcohol abuse criteria and symptom questions. Logistic regressions were performed controlling for demographics. The relationship between alcohol abuse severity indicators and income was modeled using polytomous regression. Findings Among the alcohol abuse criteria, hazardous use is the most prevalent and the only criterion to have a significant positive relationship with income (F = 20.3, df = 3, P < 0.0001). Among the hazardous use symptoms, driving after drinking (F = 13.0, df = 3, P < 0.0001) and driving while drinking (F = 9.2, df = 3, P < 0.0001) were related positively to income.

CONCLUSIONS: Because hazardous use is the most commonly endorsed criterion of alcohol abuse, the link with income raises questions about whether the current alcohol abuse diagnosis can capture the full range of alcohol abusers in every socio-economic class. While many psychiatric disorders exhibit an inverse relationship with socio-economic status, a selection bias may cause the alcohol abuse diagnosis to have an artificially positive relationship with income due to the necessity for access to a vehicle to be diagnosed.