The Symptom-Associated Pathway to Substance Use and Misuse during Adolescence

项目摘要 疼痛和其他症状，如焦虑，疲劳和嗜睡往往共同发生，持续到成年， 增加了青少年的健康风险。例如，管理不善的疼痛，疲劳和心理症状 可能有助于危险的自我管理行为，如使用和滥用处方药和其他 物质.青少年时期的这些危险行为和药物暴露与以下因素有关： 处方药滥用和物质使用（PDM/SU）进入成年期。更重要的是，我们对 持续的症状轨迹在儿童期和青春期发展。我们也不知道 家庭和其他环境因素会影响儿童的症状轨迹，或者它们如何影响 由客户驱动的PDM/SU行为。由于持续性或复发性疼痛、心理问题和PDM/SU 这些因素往往在青春期出现，因此，更好地了解这些因素之间的关系至关重要。 同样重要的是，我们了解家庭和环境因素，可以帮助保护青少年与 持续的症状轨迹，从从事危险的自我药疗或PDM/SU行为。我们的总目标 这项研究的目的是确定和制定最佳干预措施，以预防或减少与糖尿病相关的 PDM/SU在青少年中。我们的第一个目标是确定早期的症状概况（或“签名”）， 青春期表明易受1）持续或恶化的疼痛，心理和躯体（身体） 症状（P-PSS）。我们还将确定家庭和环境中相关的关键因素， 早期干预的主要目标。为了实现这一目标，我们将使用11，875名儿童的数据， 国家纵向青少年，大脑和认知发展（ABCD）研究。在目标1中，我们 根据13岁时的P-PSS（症状）轨迹区分儿童，并将确定 儿童健康、家庭健康和环境因素对这些轨迹的影响程度。在目标2中， 将展示具有最脆弱（持续/恶化）症状轨迹的儿童如何处于风险之中 15/16岁时的持续症状和PDM/SU行为。我们还将确定关键的干预措施， 增强或降低持续症状和PDM/SU风险的目标（儿童、家庭和环境） 行为在目标3中，我们将使用动态模拟建模来检查选定的 针对这些主要目标的干预措施，以破坏从症状到PDM/SU的路径。这项研究将 提供最全面的了解与PDM相关的途径/SU在青少年，到目前为止。 我们的发现不仅将提高我们对青少年症状进展和关键风险因素的认识， 但将为预防或减少药物滥用的最佳干预措施提供信息 通路

PROJECT SUMMARY Pain and other symptoms such as anxiety, fatigue, and somnolence often co-occur, persist into adulthood, and heighten health risks for adolescents. For instance, poorly managed pain, fatigue and psychological symptoms may contribute to risky self-management behavior such as use and misuse of prescription drugs and other substances. These risky behaviors and drug exposures during teenage years have been associated with prescription drug misuse and substance use (PDM/SU) into adulthood. Importantly, we know little about how persistent symptom trajectories develop during childhood and adolescence. We also know little about how family and other environmental factors influence children’s symptom trajectories or how they contribute to symptom-motivated PDM/SU behavior. Since persistent or recurrent pain, psychologic problems, and PDM/SU often emerge during adolescence, a better understanding of the relationship between these factors is critical. Equally important is that we understand the family and environmental factors that can help protect teens with persistent symptom trajectories from engaging in risky self-medication or PDM/SU behavior. Our overall goal with this research is to identify and strategize optimal interventions to prevent or reduce symptom-associated PDM/SU among teens. Our first objective is to identify a symptom profile (or “signature”) during early adolescence that indicates vulnerability to 1) persistent or worsening pain, psychological, and somatic (body) symptoms (P-PSS). We will also identify key factors in the family and environment that are relevant and primary targets for early intervention. To accomplish this, we will use data from the 11,875 children enrolled in the national longitudinal Adolescent, Brain, and Cognitive Development (ABCD) Study. In Aim 1, we will differentiate children based on their P-PSS (symptom) trajectories at age 13 years, and will determine the degree to which child health, family health and environmental factors influence these trajectories. In Aim 2, we will demonstrate how children with the most vulnerable (persistent/worsening) symptom trajectory are at risk for ongoing symptoms and PDM/SU behavior by age 15/16 years. We will also identify key interventional targets (child, family and environmental) that enhance or reduce the risk for ongoing symptoms and PDM/SU behavior. In Aim 3, we will use dynamic simulation modeling to examine the potential impact of selected interventions addressing these prime targets to disrupt the path from symptoms to PDM/SU. This research will provide the most comprehensive understanding of the symptom-related pathway to PDM/SU in teens, to date. Our findings will not only improve our knowledge about adolescent symptom progression and key risk factors, but will inform the optimal application of interventions to prevent or curtail the symptom-to-substance use pathway.