A network approach to modeling comorbid internalizing and alcohol use disorders.
A network approach to modeling comorbid internalizing and alcohol use disorders.
复制标题
DOI：
10.1037/abn0000257
复制
发表时间：
2017-04
影响因子：
4.6
通讯作者：
Kushner MG
中科院分区：
文献类型：
--
作者：
Anker JJ;Forbes MK;Almquist ZW;Menk JS;Thuras P;Unruh AS;Kushner MG
内化障碍与酒精使用障碍（AUD）共同发生，其发生率超过了机会，并危及常规AUD治疗。合并症的“恶性循环”模型将饮酒科普（DTC）指定为这些疾病之间的联系，如果不直接解决，就会破坏传统治疗的有效性。基于这一模式的干预措施已被证明是成功的，但没有直接证据表明DTC如何以及在多大程度上有助于维持合并症。在本研究中，我们使用网络分析来描述内化症状，酒精渴望和饮酒行为的症状特异性分组之间的关联，以及DTC和恶性循环模型中指定的其他诊断外变量（例如，自我效能感（self-efficacy）。对362名在住宅AUD治疗开始时评估的患有焦虑和AUD共病的个体进行的网络分析表明，虽然内化条件和饮酒元素只有微弱的直接关联，但它们与DTC和感知压力密切相关。与此相一致的是，中心性指数表明，DTC在其与所有其他网络元素的“连通性”方面被列为网络中最中心/最重要的元素。一系列的模型模拟，其中个别元素进行了统计控制，证明DTC占网络中与饮酒相关的元素和内化元素之间的所有关系，没有其他变量有这种效果。综上所述，我们的研究结果表明，DTC可能作为一个“基石”的过程，在维持共病之间的内化障碍和AUD。
Internalizing disorders co-occur with alcohol use disorder (AUD) at a rate that exceeds chance and compromise conventional AUD treatment. The “vicious cycle” model of comorbidity specifies drinking to cope (DTC) as a link between these disorders that, when not directly addressed, undermines the effectiveness of conventional treatments. Interventions based on this model have proven successful but there is no direct evidence for how and to what extent DTC contributes to the maintenance of comorbidity. In the present study, we used network analysis to depict associations between syndrome-specific groupings of internalizing symptoms, alcohol craving, and drinking behavior, as well as DTC and other extradiagnostic variables specified in the vicious cycle model (e.g., perceived stress and coping self-efficacy). Network analyses of 362 individuals with comorbid anxiety and AUD assessed at the beginning of residential AUD treatment indicated that while internalizing conditions and drinking elements had only weak direct associations, they were strongly connected with DTC and perceived stress. Consistent with this, centrality indices showed that DTC ranked as the most central/important element in the network in terms of its “connectedness” to all other network elements. A series of model simulations—in which individual elements were statistically controlled for—demonstrated that DTC accounted for all the relationships between the drinking-related elements and internalizing elements in the network; no other variable had this effect. Taken together, our findings suggest that DTC may serve as a “keystone” process in maintaining comorbidity between internalizing disorders and AUD.