Research update

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Minority with panic disorder receive adequate treatment
Parents often unaware of teen substance use
Early alcohol dependence decreases likelihood of seeking treatment

Minority with panic disorder receive adequate treatment

Although panic disorder affects as much as five per cent of the American population at some point, most people with this disorder do not receive proven and effective treatment, according to a study from the University of Washington in Seattle. The disorder results in considerable functional limitations and reduced quality of life, especially when accompanied by agoraphobia. The social costs of panic disorder include increased health care use, absenteeism and reduced workplace productivity. Researchers searched articles in MEDLINE, PSYCHINFO and the Cochrane Library dating from 1980 to 2005, with a focus on articles from the past 10 years. They found that the five per cent prevalence rate of panic disorder among Americans, reported in a 2005 study, contrasted with much lower estimates from other countries, possibly reflecting differences in diagnostic methodology and diagnostic criteria. Although a number of treatments have proven effective for panic disorder, notably selective serotonin reuptake inhibitors and cognitive-behavioural therapy, the researchers found that only 19 to 40 per cent of individuals receive treatment that meets minimum standards. They recommend that dissemination of proven treatments by frontline health care providers be made a public health priority and that new approaches be found to overcome barriers to treatment, such as difficulties in detection and diagnosis. They also urge concentrating prevention efforts at or before late adolescence, when the onset of panic disorder is known to peak.

Lancet, September 16, 2006, v. 368: 1023–1032. Peter P. Roy-Byrne et al., Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, Washington

Parents often unaware of teen substance use

Parents appear to be unaware of alcohol and other drug use among their teenage children roughly half of the time, according to a recent study. Researchers at the Washington University School of Medicine in St. Louis, Missouri, studied 591 pairs of adolescents (age 12 to 17) and their parents who participated in the Collaborative Study on the Genetics of Alcoholism from 1991 to 1998. Participants were assessed using adolescent and parent versions of the Semi-Structured Assessment for the Genetics of Alcoholism, providing diagnoses of DSM-III-R substance abuse or dependence. The parent report, provided by the mother in 86 per cent of cases, was intended to determine parents’ understanding of their children’s substance use. Alcohol was the most commonly used substance (54% of the teens), followed by tobacco (44%) and marijuana (23%). When teens reported substance use, parents accurately reported alcohol use only 50 per cent of the time, tobacco use 55 per cent of the time and marijuana use 47 per cent of the time. Parent reports of substance abuse or dependence were even less accurate, agreeing with adolescent reports 27 per cent of the time for alcohol and 26 per cent of the time for marijuana. Parents provided accurate reports of other drug use (such as cocaine, stimulants, sedatives, opiates and hallucinogens) only 28 per cent of the time. The accuracy of parental reports increased with the child’s age, perhaps reflecting the fact that parents of older teens have had more opportunities to become aware of their child’s substance use. The authors conclude that adolescent self-report should be the preferred method for assessing adolescent substance use.

Alcoholism: Clinical and Experimental Research, October 2006, v. 30: 1699–1710. Laura Jean Bierut et al., Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.

Early alcohol dependence decreases likelihood of seeking treatment

People who become alcohol dependent at an early age are less likely to seek treatment than those who develop a dependency later in life, according to research from the Boston University School of Public Health. The study used data from 43,093 adults over age 18 gathered in 2001–2002 as part of the National Epidemiologic Survey on Alcohol and Related Conditions conducted by the National Institute on Alcohol Abuse and Alcoholism in the United States. Researchers concentrated on the 4,778 individuals whose survey answers warranted a diagnosis of alcohol dependence at some point in their lives. The researchers found that 47 per cent of the alcohol-dependent individuals became dependent before age 21 and 68 per cent became dependent before age 25; only 21 per cent became dependent at age 30 or older. Those who developed dependence before age 25 were less likely to seek treatment than those who became dependent after age 30. If they did seek help, they waited longer to do so. This was despite the fact that this group experienced more dependence episodes and dependence symptoms, and was more likely to show signs of chronic relapsing alcohol dependence. The authors recommend additional research “to examine the effects of screening adolescent populations for alcohol problems and offering counselling in a wider variety of settings such as school-based clinics and general pediatric settings.”

Pediatrics, September 2006, v. 118: 755–763. Ralph W. Hingson et al., Youth Alcohol Prevention Center, Boston University School of Public Health, Boston, Massachusetts.