social, and psychological pathology (17). In the World Health Organization (WHO) lexicon, the subthreshold form of heavy drinking is termed “hazardous alcohol use,” while the term “harmful alcohol use,” comparable with the DSM alcohol-abuse diagnosis, is defined as a pattern of alcohol use that has actually caused harm (18).

According to the WHO, the proportion of persons in the general population with alcohol dependence is 0% to 5%, with hazardous or harmful drinking it is 5% to 15%, and the rest either low-risk drinkers or nondrinkers (17). Due to the high prevalence of hazardous levels of alcohol use, the WHO has made significant efforts to initiate recognition and treatment of hazardous alcohol use (19).

Therefore, since the DSM-III-R alcohol-abuse disorder diagnosis is relatively unreliable, and a hazardous level of alcohol use is considered a significant public health problem, we decided to investigate the association between phobic disorders and hazardous levels of alcohol use in a community sample. Further, the study aimed to investigate the differences in magnitude of association between various subtypes of phobic disorders and various levels of alcohol use.

Methods

Survey

The OHS is a province-wide, cross-sectional population health survey designed and collected by the Ontario Ministry of Health in consultation with Statistics Canada. The Mental Health Supplement to the OHS (OHS-MHS) was conducted to study the prevalence, comorbidity, and disability of psychiatric conditions. Boyle and Colleagues have provided a comprehensive description of the survey (20). Respondents for the supplement were drawn from households (n = 13 002) participating in the OHS. One person per household was selected, with a response rate of 9953 (76.5%). The 9953 individuals participating in the supplement represent 67.4% of the original 14 758 households selected for the OHS.

Between December 1990 and April 1991, respondents were interviewed to diagnose DSM-III-R psychiatric disorders. Lay interviews used the University of Michigan Composite International Diagnostic Interview (UM-CIDI) to diagnose.

This same instrument was used to diagnose psychiatric disorders in the NCS (5). This instrument demonstrated high rates of reliability in field trials for almost all diagnoses except mania and psychosis (21).

In the OHS-MHS, the UM-CIDI provided prevalence data on 14 DSM-III-R psychiatric disorders: anxiety disorders (social phobia, simple phobia, agoraphobia, panic disorder, and generalized anxiety disorder); affective disorders (major depressive disorder, dysthymia, and manic disorder); bulimia nervosa; substance use disorders (alcohol, marijuana, and other substance abuse or dependence); and antisocial behaviours (antisocial personality disorder and adult antisocial behaviour).

An abbreviated interview was conducted on subjects over age 65 years. The data reported here are based on information from respondents age 15 to 64 years (n = 8116).

Reclassification of Phobic Disorder Diagnoses

Phobic disorders were assessed by asking respondents whether they had ever experienced any of 19 potentially phobic situations, in which they were always so afraid that they either tried to avoid, or felt very uncomfortable in, the situation. The phobic situation descriptors were presented in 3 lists (5 situations for agoraphobia, 8 for simple phobia, and 6 for social phobia).

Two recent studies have demonstrated that the phobic disorders diagnosed by the UM-CIDI may require reclassification. First, Kessler and others demonstrated that social phobia can be reliably distinguished into 2 subtypes: a speaking subtype (SP-speaking), where respondents have social fears limited to speaking in small or large groups, and a generalized subtype that involves fear and avoidance of multiple situations (SP-complex) (22). The analyses for the present study were carried out looking both at social phobia as a group and at the 2 social phobia subtypes separately.

Second, Wittchen and others demonstrated that the CIDI agoraphobia diagnosis requires revision (23). They examined the CIDI diagnosis of agoraphobia in a sample of 3021 Dutch adolescents by clinical reappraisal.