Marijuana use, problems, and cannabis use disorders in OIF/OEF/OND veterans

描述(由申请人提供)：尽管最近伊拉克和阿富汗战争中的美国退伍军人中精神健康问题的比率很高，包括药物使用障碍，但大多数报告都集中在过度饮酒和相关问题上。虽然临床医生面临着越来越多的关于退伍军人大量使用大麻和存在问题的报告，但关于这种药物及其与情感障碍(例如，创伤后应激障碍和严重抑郁障碍)之间关系的研究几乎不存在。关于大麻使用的自然过程和相关问题的研究很少，也没有关于部署后退伍军人中大麻使用和情感障碍并存的前瞻性研究。该应用程序的目标是对400名从退伍军人管理局医疗中心招募的持久自由行动(OEF)、伊拉克自由行动(OIF)和新黎明行动(OND)退伍军人的大麻使用轨迹、相关问题、大麻使用障碍和伴随的情感障碍进行首次全面的前瞻性调查。拟议的纵向设计在检验理论上确定的大麻使用轨迹变化预测因素方面是一个特别的优势。将使用潜在过渡分析检查大麻使用和滥用、酒精和其他药物使用障碍的变化(一年内升级和降级)和稳定性，并使用潜在增长曲线建模检查纵向关联。这项拟议的研究将确定假定的机制(使用大麻作为应对原因)，并调查个人差异(情绪脆弱性、认知、心理社会和身体/医学因素)的缓和效果，这些因素可能解释负面情绪(DSM-IV情绪或焦虑障碍和/或状态负面情感)与大麻使用/障碍之间的关系。使用按比例分配的分层抽样，将选择每周经常吸食大麻的人、过去一个月的吸食者、过去一年不经常吸食大麻的人和有终身吸食大麻史的非吸食者的同等比例，以便在检查大麻使用的纵向变化模式时考虑到异质性。这项研究有可能提供关于共病和成瘾障碍发展的基础机制的信息，这是一个临床问题，由于与成瘾相关的成本和精神健康残疾的增加，对公共健康有重大影响。这项研究的结果将对OEF/OIF/OND退伍军人的评估和治疗具有广泛的影响，这些退伍军人同时患有药物使用和情感障碍，并最终为他们提供更高质量的生活。

DESCRIPTION (provided by applicant): Despite the recent attention to high rates of mental health problems including substance use disorders among the US veterans of the wars in Iraq and Afghanistan, most of the reports have been focused on excessive alcohol use and related problems. While clinicians are confronted with increasing reports of heavy and problematic marijuana use among the veterans, research on this drug and its association with affective disorders (e.g., post-traumatic stress disorder and major depressive disorder) is virtually nonexistent. There is a paucity of studies on the natural course of marijuana use and associated problems and there are no prospective studies on the comorbidity of cannabis use and affective disorders among veterans following deployment. The goal of this application is to conduct the first comprehensive prospective investigation of the trajectories of marijuana use, related problems, cannabis use disorders and concomitant affective disorders among 400 Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans recruited from the Veterans Administration Medical Center post-deployment. The proposed longitudinal design is a particular strength in examining theoretically-determined predictors of change in marijuana use trajectories. Change (escalation and de-escalation over one year) and stability in marijuana use and abuse, alcohol, and other drug use disorders will be examined using latent transition analysis, and longitudinal associations will be examined using latent growth curve modeling. The proposed study will identify putative mechanisms (using marijuana for coping reasons) and investigate the moderating effects of individual differences (emotional vulnerability, cognitive, psychosocial, and physical/medical factors) that may explicate the relationship between negative affect (DSM-IV mood or anxiety disorder and/or state negative affectivity) and marijuana use/disorders. Using stratified sampling with proportional allocation, an equal proportion of frequent weekly marijuana users, past month users, infrequent past year users and non-users with lifetime history of marijuana use will be selected to allow for heterogeneity in examining longitudinal patterns of change in marijuana use. This study has the potential to yield information about the mechanisms that underlie the development of co morbidity and addictive disorders, a clinical problem that has substantial impact on public health due to increasing costs of addiction-related and mental health disability. Findings from this study will have wide-ranging implications for the assessment and treatment of OEF/OIF/OND veterans with co-occurring substance use and affective disorders and ultimately for providing them with a higher quality of life.