Epidemiology of DSM-5 Drug Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III.
Epidemiology of DSM-5 Drug Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III.
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DOI：
10.1001/jamapsychiatry.2015.2132
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发表时间：
2016-01
期刊：
影响因子：
25.8
通讯作者：
Hasin, Deborah S.
中科院分区：
文献类型：
--
作者：
Grant, Bridget F.;Saha, Tulshi D.;Ruan, W. June;Goldstein, Rise B.;Chou, S. Patricia;Jung, Jeesun;Zhang, Haitao;Smith, Sharon M.;Pickering, Roger P.;Huang, Boji;Hasin, Deborah S.
目前关于DSM-5药物使用障碍（DUD）的流行程度、社会人口学和临床概况的信息是有限的。鉴于美国目前的社会和经济背景以及新的诊断系统，需要从单一统一的数据源获得最新的国家信息。在DSM-5 DUD诊断的总体和严重程度方面，提出具有全国代表性的患病率、相关性、精神合并症、残疾和治疗的研究结果。在2012-2013年全国酒精及相关疾病流行病学调查iii中，对36309名成年人进行了面对面访谈，这是美国的一项横断面代表性调查。住户回应率为72%；个人层面反应率84%；总体反应率为60.1%。数据收集于2012年4月至2013年6月，分析时间为2015年2月至3月。基于安非他明、大麻、俱乐部毒品、可卡因、致幻剂、海洛因、非海洛因阿片类药物、镇静剂/镇定剂和/或溶剂/吸入剂使用障碍的12个月和终生DUD。12个月和终生DUD患病率分别为3.9%和9.9%。药物使用障碍在男性、白人和印第安人、年轻、未婚或未婚的成年人、受教育程度和收入较低的人以及居住在西部的人中普遍更大。发现12个月和终生DUD与其他物质使用障碍之间存在显著关联。任何12个月的DUD与重度抑郁症（比值比[OR]， 1.3; 95% CI, 1.09-1.64）、心境不良（OR, 1.5; 95% CI, 1.09-2.02）、双相情感障碍（OR, 1.5; 95% CI, 1.06-2.05）、创伤后应激障碍（OR, 1.6; 95% CI, 1.27-2.10）、反社会人格障碍（OR, 1.4; 95% CI, 1.11-1.75）、边缘型人格障碍（OR, 1.8; 95% CI, 1.41-2.24）和分裂型人格障碍（OR, 1.5; 95% CI, 1.18-1.87）之间也存在显著关联。任何终身DUD也发现了类似的关联，除了终生DUD还与广泛性焦虑障碍（OR, 1.3; 95% CI, 1.06-1.49）、惊恐障碍（OR, 1.3; 95% CI, 1.06-1.59）和社交恐惧症（OR, 1.3; 95% CI, 1.09-1.64）相关。12个月的DUD与显著的残疾相关，随着DUD严重程度的增加而增加。在12个月和终生DUD的受访者中，分别只有13.5%和24.6%的人接受了治疗。DSM-5 DUD是一种常见的，高度合并症和致残性疾病，在美国大部分未得到治疗。这些发现表明需要更多的研究来更详细地了解广泛的关系；估计不定期发展项目目前的经济成本；调查关于病因、慢性和治疗使用的假设；并向决策者提供关于服务提供和研究资源分配的信息。研究结果还表明，迫切需要消除DUD的污名，并对公众、临床医生和政策制定者进行有关治疗的教育，以鼓励受影响的个人寻求帮助。
Current information on the prevalence and sociodemographic and clinical profiles of individuals in the general population with DSM-5 drug use disorder (DUD) is limited. Given the present societal and economic context in the United States and the new diagnostic system, up-to-date national information is needed from a single uniform data source. To present nationally representative findings on the prevalence, correlates, psychiatric comorbidity, disability, and treatment of DSM-5 DUD diagnoses overall and by severity level. In-person interviews were conducted with 36 309 adults in the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions–III, a cross-sectional representative survey of the United States. The household response rate was 72%; person-level response rate, 84%; and overall response rate, 60.1%. Data were collected April 2012 through June 2013 and analyzed from February through March 2015. Twelve-month and lifetime DUD, based on amphetamine, cannabis, club drug, cocaine, hallucinogen, heroin, nonheroin opioid, sedative/tranquilizer, and/or solvent/inhalant use disorders. Prevalences of 12-month and lifetime DUD were 3.9% and 9.9%, respectively. Drug use disorder was generally greater among men, white and Native American individuals, younger and previously or never married adults, those with lower education and income, and those residing in the West. Significant associations were found between 12-month and lifetime DUD and other substance use disorders. Significant associations were also found between any 12-month DUD and major depressive disorder (odds ratio [OR], 1.3; 95% CI, 1.09–1.64), dysthymia (OR, 1.5; 95% CI, 1.09–2.02), bipolar I (OR, 1.5; 95% CI, 1.06–2.05), posttraumatic stress disorder (OR, 1.6; 95% CI, 1.27–2.10), and antisocial (OR, 1.4; 95% CI, 1.11–1.75), borderline (OR, 1.8; 95% CI, 1.41–2.24), and schizotypal (OR, 1.5; 95% CI, 1.18–1.87) personality disorders. Similar associations were found for any lifetime DUD with the exception that lifetime DUD was also associated with generalized anxiety disorder (OR, 1.3; 95% CI, 1.06–1.49), panic disorder (OR, 1.3; 95% CI, 1.06–1.59), and social phobia (OR, 1.3; 95% CI, 1.09–1.64). Twelve-month DUD was associated with significant disability, increasing with DUD severity. Among respondents with 12-month and lifetime DUD, only 13.5% and 24.6% received treatment, respectively. DSM-5 DUD is a common, highly comorbid, and disabling disorder that largely goes untreated in the United States. These findings indicate the need for additional studies to understand the broad relationships in more detail; estimate present-day economic costs of DUDs; investigate hypotheses regarding etiology, chronicity, and treatment use; and provide information to policy makers about allocation of resources for service delivery and research. Findings also indicate an urgent need to destigmatize DUD and educate the public, clinicians, and policy makers about its treatment to encourage affected individuals to obtain help.
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