Testing the Drug Substitution Switching-Addictions Hypothesis A Prospective Study in a Nationally Representative Sample
Testing the Drug Substitution Switching-Addictions Hypothesis A Prospective Study in a Nationally Representative Sample
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DOI：
10.1001/jamapsychiatry.2014.1206
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发表时间：
2014-11-01
期刊：
影响因子：
25.8
通讯作者：
Olfson, Mark
中科院分区：
文献类型：
--
作者：
Blanco, Carlos;Okuda, Mayumi;Olfson, Mark
重要性从物质使用障碍（SUD）缓解的成年人通常被认为是发展另一种SUD的风险增加。更好地了解药物替代的患病率和风险因素将为临床监测和管理提供信息。目的：确定与SUD未缓解相比，SUD缓解是否会增加3年随访后新发SUD的风险，以及社会人口学特征和精神疾病（包括人格障碍）是否能独立预测新发SUD。一项前瞻性队列研究，数据来自全国酒精和相关疾病流行病学调查的34653名成年人的全国代表性样本。参与者接受了两次采访，间隔3年（第一波，2001-2002年;波2，主要结果和指标：我们比较了在第1波时至少有1次SUD，但在第2波时未从任何SUD缓解的个体中新发SUD的情况。（n = 3275）和在波1时至少有1个当前SUD并在波2时缓解的个体中结果在第2波评估时，约五分之一（n = 2741）的总样本发生了新发SUD。在此期间从1个SUD缓解的个体比未缓解的个体发展新的SUD的可能性显著更低（13.1%对27.2%，P <0.001）。结果对样品质量标准具有耐用性。一个例外是，药物使用障碍的缓解增加了新发SUD的几率（比值比[OR] = 1.46; 95%CI，1.11-1.92）。然而，在调整基线SUD数量后，药物使用障碍缓解降低了新发SUD的几率（OR = 0.66; 95% CI，0.46-0.95），而基线SUD数量增加了这些几率（OR=1.68; 95% CI，1.43-1.98）。作为男性，年轻的年龄，从未结婚，有一个较早的年龄在物质使用的发病，精神科合并症显着增加了一个新的发病SUD的几率在后续period.CONCLUSIONS和RELEVANCE相比，那些谁不从SUD汇款，汇款人有不到一半的风险，开发一个新的SUD。与临床知识相反，达到缓解通常不会导致药物替代，而是与新SUD发作的风险较低相关。
IMPORTANCE Adults who remit from a substance use disorder (SUD) are often thought to be at increased risk for developing another SUD. A greater understanding of the prevalence and risk factors for drug substitution would inform clinical monitoring and management.OBJECTIVE To determine whether remission from an SUD increases the risk of onset of a new SUD after a 3-year follow-up compared with lack of remission from an SUD and whether socio-demographic characteristics and psychiatric disorders, including personality disorders, independently predict a new-onset SUD.DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study where data were drawn from a nationally representative sample of 34 653 adults from the National Epidemiologic Survey on Alcohol and Related Conditions. Participants were interviewed twice, 3 years apart (wave 1, 2001-2002; wave 2, 2004-2005).MAIN OUTCOMES AND MEASURES We compared new-onset SUDs among individuals with at least 1 current SUD at wave 1 who did not remit from any SUDs at wave 2 (n = 3275) and among individuals with at least 1 current SUD at wave 1 who remitted at wave 2 (n = 2741).RESULTS Approximately one-fifth (n = 2741) of the total sample had developed a new-onset SUD at the wave 2 assessment. Individuals who remitted from 1 SUD during this period were significantly less likely than those who did not remit to develop a new SUD (13.1% vs 27.2%, P < .001). Results were robust to sample specification. An exception was that remission from a drug use disorder increased the odds of a new SUD (odds ratio [OR] = 1.46; 95% CI, 1.11-1.92). However, after adjusting for the number of SUDs at baseline, remission from drug use disorders decreased the odds of a new-onset SUD (OR = 0.66; 95% CI, 0.46-0.95) whereas the number of baseline SUDs increased those odds (OR=1.68; 95% CI, 1.43-1.98). Being male, younger in age, never married, having an earlier age at substance use onset, and psychiatric comorbidity significantly increased the odds of a new-onset SUD during the follow-up period.CONCLUSIONS AND RELEVANCE As compared with those who do not remit from an SUD, remitters have less than half the risk of developing a new SUD. Contrary to clinical lore, achieving remission does not typically lead to drug substitution but rather is associated with a lower risk of new SUD onsets.