title: Sociodemographic correlates of transitions from alcohol use to disorders and remission in the São Paulo megacity mental health survey, Brazil.
abstract: OBJECTIVE
  To evaluate sociodemographic correlates associated with transitions from alcohol use to disorders and remission in a Brazilian population.
  
  
  METHODS
  Data are from a probabilistic, multi-stage clustered sample of adult household residents in the São Paulo Metropolitan Area. Alcohol use, regular use (at least 12 drinks/year), DSM-IV abuse and dependence and remission from alcohol use disorders (AUDs) were assessed with the World Mental Health version of the Composite International Diagnostic Interview. Age of onset (AOO) distributions of the cumulative lifetime probability of each alcohol use stage were prepared with data obtained from 5037 subjects. Correlates of transitions were obtained from a subsample of 2942 respondents, whose time-dependent sociodemographic data were available.
  
  
  RESULTS
  Lifetime prevalences were 85.8% for alcohol use, 56.2% for regular use, 10.6% for abuse and 3.6% for dependence; 73.4 and 58.8% of respondents with lifetime abuse and dependence, respectively, had remitted. The number of sociodemographic correlates decreased from alcohol use to disorders. All transitions across alcohol use stages up to abuse were consistently associated with male gender, younger cohorts and lower education. Importantly, low education was a correlate for developing AUD and not remitting from dependence. Early AOO of first alcohol use was associated with the transition of regular use to abuse.
  
  
  CONCLUSIONS
  The present study demonstrates that specific correlates differently contribute throughout alcohol use trajectory in a Brazilian population. It also reinforces the need of preventive programs focused on early initiation of alcohol use and high-risk individuals, in order to minimize the progression to dependence and improve remission from AUD.
authors.affiliation: Section of Psychiatric Epidemiology-LIM 23, Department and Institute of Psychiatry, School of Medicine, University of São Paulo, R. Dr. Ovidio Pires de Campos, CEAPESQ, São Paulo, Brazil.
authors.forename: Camila Magalhães
authors.initials: CM
authors.lastname: Silveira
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Viana
authors.forename: Erica Rosanna
authors.initials: ER
authors.lastname: Siu
authors.forename: Arthur Guerra
authors.initials: AG
authors.lastname: de Andrade
authors.forename: James C
authors.initials: JC
authors.lastname: Anthony
authors.forename: Laura Helena
authors.initials: LH
authors.lastname: Andrade
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000378:metabolism; D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism; D001938:Brazil / Q000453:epidemiology; D002947:Cities; D003710:Demography; D018450:Disease Progression; D005260:Female; D006306:Health Surveys; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D011157:Population Dynamics; D011569:Psychiatric Status Rating Scales; D012075:Remission, Spontaneous; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism; D013997:Time Factors; D055815:Young Adult