Does the 'gateway' matter? Associations between the order of drug use initiation and the development of drug dependence in the National Comorbidity Study Replication
Does the 'gateway' matter? Associations between the order of drug use initiation and the development of drug dependence in the National Comorbidity Study Replication
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DOI：
10.1017/s0033291708003425
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发表时间：
2009-01-01
影响因子：
6.9
通讯作者：
Kessler, R. C.
中科院分区：
文献类型：
--
作者：
Degenhardt, L.;Chiu, W. T.;Kessler, R. C.
背景。开始吸毒的“门户”模式描述了一个规范的顺序，首先是使用酒精和烟草，其次是大麻，然后是其他非法药物。先前的研究表明，“违反”这个序列可能是后来问题的预测因素，但没有考虑其他决定因素。我们使用美国国家共病调查复制（NCS-R）的数据，研究了先前存在的精神障碍和社会人口统计学在解释违规行为的预测效果方面的作用。NCS-R是一项具有全国代表性的面对面家庭调查，9282名年龄在18岁及以上的英语受访者使用世界卫生组织（WHO）复合国际诊断访谈（CIDI）来评估DSM-IV精神和物质障碍。使用回顾性发病年龄报告和定义为与规范起始顺序不一致的“违规”来估计药物起始。使用多变量逻辑回归检验违规的预测因子。使用离散时间生存分析来观察违规是否预示着向依赖的进展。除了那些在使用大麻之前就开始使用其他非法药物的人，酒精和其他非法药物依赖的风险略有增加外，违反门户规定的行为基本上与后来的依赖风险无关。早发性内化障碍是门户违规的预测因素，内化障碍和外化障碍都增加了所有药物使用者的依赖风险。药物使用开始遵循强烈的规范模式，偏离这种模式并不能强烈预测后来的问题。相比之下，已经出现精神健康问题的青少年有偏离药物开始的规范顺序和发展为依赖的风险。
Background. The 'gateway' pattern of drug initiation describes a normative sequence, beginning with alcohol and tobacco use, followed by cannabis, then other illicit drugs. Previous work has suggested that 'violations' of this sequence may be predictors of later problems but other determinants were not considered. We have examined the role of pre-existing mental disorders and sociodemographics in explaining the predictive effects of violations using data from the US National Comorbidity Survey Replication (NCS-R).Method. The NCS-R is a nationally representative face-to-face household survey of 9282 English-speaking respondents aged 18 years and older that used the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) to assess DSM-IV mental and substance disorders. Drug initiation was estimated using retrospective age-of-onset reports and 'violations' defined as inconsistent with the normative initiation order. Predictors of violations were examined using multivariable logistic regressions. Discrete-time survival analysis was used to see whether violations predicted progression to dependence.Results. Gateway violations were largely unrelated to later dependence risk, with the exception of small increases in risk of alcohol and other illicit drug dependence for those who initiated use of other illicit drugs before cannabis. Early-onset internalizing disorders were predictors of gateway violations, and both internalizing and externalizing disorders increased the risks of dependence among users of all drugs.Conclusions. Drug use initiation follows a strong normative pattern, deviations from which are not strongly predictive of later problems. By contrast, adolescents who have already developed mental health problems are at risk for deviations from the normative sequence of drug initiation and for the development of dependence.