Trajectories of concurrent substance use disorders: A developmental, typological approach to comorbidity
Trajectories of concurrent substance use disorders: A developmental, typological approach to comorbidity
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DOI：
10.1097/00000374-200006000-00022
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发表时间：
2000-06-01
影响因子：
3.2
通讯作者：
Wood, PK
中科院分区：
文献类型：
--
作者：
Jackson, KM;Sher, KJ;Wood, PK
背景：虽然烟酒使用障碍是高度并存的，但对这些障碍的合并过程知之甚少。方法：本研究利用潜在分类分析来检查烟酒使用障碍共病的纵向模式。研究对象为449名年轻人(基线年龄18.5岁；男性占48%；父亲有酗酒史占51%)，在7年内进行了5次评估。结果：随着时间的推移，酒精或烟草使用障碍被识别为5种纵向类型：非诊断性；发育性局限性酒精使用障碍；慢性酒精使用障碍；慢性烟草使用障碍；以及合并酒精和烟草使用障碍。这些类型可以根据酗酒家族史、身份和性别加以区分。病因学上重要的第三个变量(酒精预期、行为控制不足、童年压力)在家族史和潜在类别之间的关系中起中介作用。结论：酒精使用障碍的特征通常没有考虑到异质性的重要来源，如病程或共病。通过同时对烟草依赖的发育过程和共病进行建模，我们能够确定单一和同时存在的物质使用障碍的不同轨迹。这种多物质轨迹代表了有意义的亚型，尽管它们有很大的共同影响，但具有独特的病因学相关性。此外，从干预策略的角度来看，这些亚型可能代表不同的群体。
Background: Although alcohol and tobacco use disorders are highly comorbid, little is known regarding the combined course of these disorders.Methods: The current study utilized latent class analysis to examine longitudinal patterns of alcohol-tobacco use disorder comorbidity. Participants were 449 young adults (baseline age, 18.5 years; 48% male; 51% with paternal history of alcoholism) assessed five times over 7 years.Results: Five longitudinal types of alcohol or tobacco use disorder over time were identified: nondiagnosing; developmentally limited alcohol use disorder; chronic alcohol use disorder; chronic tobacco use disorder; and comorbid alcohol and tobacco use disorder. These typologies were distinguishable on the basis of family history of alcoholism status and sex. Etiologically important third variables (alcohol expectancies, behavioral undercontrol, childhood stressors) mediated the relation between family history and the latent classes.Conclusions: Characterizations of alcohol use disorders typically fail to consider important sources of heterogeneity such as course or comorbidity. By simultaneously modeling developmental course and comorbidity with tobacco dependence, we were able to identify distinct trajectories of single and concurrent substance use disorders. Such multi-substance trajectories represent meaningful subtypes that, although sharing substantial common influences, have unique etiologic correlates. Additionally, these subtypes might represent distinct groups from the perspective of intervention strategies.