Adolescent AUDs: Nosology, Comorbidity and Course

人们对 DSM-IV 酒精使用障碍 (AUD) 标准应用于青少年的有效性以及青少年发病 AUD 和共病精神病理学的自然史知之甚少。 本申请提出了一项关于从青春期到成年早期 AUD 的疾病学、合并症和病程的纵向研究计划。 我们将前瞻性地研究 504 名接受成瘾治疗项目的青少年，以及 206 名青少年的代表性社区样本。 所有受试者都已参与了对一生和当前 AUD、其他药物使用障碍 (SUD) 和共病精神病理学、酒精和药物使用史以及其他功能和问题严重程度衡量标准的广泛基线评估。 拟议的研究将使用与基线评估相同的措施以及年轻人心理和社会心理功能的其他措施，完成对这些受试者的 1 年、3 年和 5 年随访评估。 纵向数据将用于实现三个具体目标：1）开发和完善青少年 AUD 诊断标准的新发展模型，并将其并发有效性和预测有效性与 DSM-IV 标准进行对比； 2) 描述从青春期到成年早期的 AUD 病程的路径和预测因素； 3) 确定共病精神病理学对青少年发病 AUD 发展轨迹的影响。 这项研究将纳入多种药物使用和其他 SUD 的更广泛背景，其中通常包含青少年发病的 AUD。 已经在大型临床样本和社区比较组中收集的广泛数据使该项目成为一个高度可行的纵向项目。 研究结果将提供关于 AUD 的自然史和整个青春期发育期的合并症及其对青少年酒精和物质障碍以及心理社会功能的影响的重要新信息。

Little is known about the validity of DSM-IV criteria for Alcohol Use Disorders (AUDs) when applied to adolescents, and the natural history of adolescent-onset AUDs and comorbid psychopathology. This application proposes a program of longitudinal research on the nosology, comorbidity and course of AUDs through adolescence and into young adulthood. We will prospectively study 504 adolescents from addiction treatment programs, and a representative community sample of 206 adolescents. All subjects already have participated in an extensive baseline assessment of lifetime and current AUDs, other Substance Use Disorders (SUDs) and comorbid psychopathology, alcohol and drug use history, and other measures of functioning and problem severity. The proposed research will complete 1- year, 3-year and 5-year follow-up assessments of these subjects, using the same measures as the baseline assessment as well as other measures of young adult psychological and psychosocial functioning. Longitudinal data will be used to address three specific aims: 1) to develop and refine a new developmental model of diagnostic criteria for adolescent AUDs, and contrast its concurrent and predictive validity with DSM-IV criteria; 2) to characterize pathways and predictors of the course of AUDs through adolescence and into young adulthood; and 3) to determine the effects of comorbid psychopathology on the developmental trajectories of adolescent-onset AUDs. This research will incorporate the broader context of polydrug use and other SUDs in which adolescent-onset AUDs are usually embedded. The extensive data already collected on a large clinical sample and a community comparison group make this a highly feasible longitudinal project. The results will provide important new information about the natural history of AUDs and comorbid conditions across the developmental period of adolescence, and their impact on young adult alcohol and substance disorders and psychosocial functioning.