Natural Course and Developmental Trajectories of Alcohol Use Disorders

描述（由申请人提供）：酒精滥用和依赖障碍在普通人群中很常见，保守估计近五分之一的美国人在其一生中会患上酒精使用障碍（AUD）。与aud相关的公共卫生问题已得到充分证明；尽管如此，关于AUDs在普通人群中的发展和过程，仍存在重要的知识空白。为了解决这些差距，拟议的研究将描述与aud自然过程相关的几个重要特征。这些包括与AUD相关的发展轨迹的多样性，以及AUD轨迹与常见共同发生的疾病（如大麻使用障碍、硬性药物使用障碍和反社会行为障碍）共享的关系的时间和顺序。拟议的研究还将报告第一次AUD发作后复发的概率和第二次AUD发作的障碍复发时间的数据。还将测试一个模型，以了解aud的短期和长期结果，这些结果反过来又对持续恢复期后复发相关过程产生影响。为了实现这些研究目标，将分析俄勒冈州青少年抑郁症项目（OADP）的现有数据集。OADP是一项以社区为基础的多代纵向研究，涵盖了从青春期到成年早期出现持续有害酒精使用模式的高峰期。本提案中描述的研究将解决先前OADP出版物中未解决的几个问题。强调了四个广泛的领域，整合了OADP的纵向和发展特征。(1)将导出描述与AUDs首次发病年龄相关的趋势的风险函数，并报告恢复时间、复发概率和障碍复发时间的数据。(2)根据AUDs在一生中的发展历程划分亚组，并报告与不同轨迹亚组相关的儿童危险因素和成人社会心理结局。(3)评估和记录AUDs与其他相关障碍之间可能存在的单向和互惠关系。(4)抑郁障碍将被评估为最初aud后可能出现的“伤疤”，进而预测未来复发的可能性。这项研究的发现有可能为AUDs的流行病学理论提供信息，有助于开发筛查工具来识别未来有AUDs风险的青少年，促进有针对性的预防计划和治疗干预措施的发展，并在有益的行为改变发生后降低复发的可能性。

DESCRIPTION (provided by applicant): Alcohol abuse and dependence disorders are common in the general population, with conservative estimates suggesting that almost 1 in 5 Americans will develop an alcohol use disorder (AUD) during their lifetime. The public heath concerns associated with AUDs have been well-documented; nonetheless, important gaps in knowledge remain concerning the development and course of AUDs in the general population. To address these gaps, the proposed research will describe several important features associated with the natural course of AUDs. These include the diversity of AUD-related developmental trajectories, as well as the timing and sequencing of relationships that AUD trajectories share with common co-occurring conditions, such as cannabis use disorders, hard drug use disorders, and antisocial behavior disorders. The proposed research will also report data on the probability of relapse following the first AUD episode and the time to disorder recurrence for those with a second AUD episode. A model will also be tested for understanding the short- and longer-term outcomes of AUDs that, in turn, have implications for relapse-related processes following periods of sustained recovery. To accomplish these research aims, an existing data set from the Oregon Adolescent Depression Project (OADP) will be analyzed. The OADP is a community-based and multi-generational longitudinal study that spans the peak period for the emergence of sustained patterns of hazardous alcohol use, from adolescence through early adulthood. The research described in this proposal will address several issues not previously addressed in prior OADP publications. Four broad areas are emphasized that integrate OADP's longitudinal and developmental features. (1) Hazard functions that describe trends associated with the age of first onset for AUDs will be derived, and data will be reported on the time to recovery, the probability of relapse, and the time to disorder recurrence. (2) Subgroups of persons will be identified based on the developmental course of AUDs over the lifetime, and childhood risk factors and adult psychosocial outcomes associated with distinct trajectory subgroups will be reported. (3) The possible unidirectional and reciprocal relationships that AUDs share with other related disorders will be evaluated and documented. (4) Depressive disorders will be evaluated as possible "scars" following initial AUDs that, in turn, predict the likelihood of future relapse. Findings from this proposed research have the potential to inform theories of the epidemiology of AUDs, aid the development of screening tools to identify youth who are at risk for future AUDs, facilitate the development of targeted prevention programs and therapeutic interventions, and reduce the likelihood of relapse once beneficial behavior change has occurred. PUBLIC HEALTH RELEVANCE: The proposed research is consistent with two broad objectives of NIAAA's Strategic Plan for Research. (1) To increase knowledge of when problematic drinking is likely to occur, the proposed research will document the natural course and developmental trajectories of alcohol use disorders (AUDs) from childhood through age 29. (2) To increase knowledge of why some people develop AUDs and others have difficulty recovering fully from initial AUD episodes, the proposed research will examine developmental trajectories that AUDs share with related disorders as well as processes that predict relapse following periods of sustained remission.