Towards a Comprehensive Developmental Model of Substance Use Disorders

描述(由申请人提供)：物质使用障碍(SUD)非常普遍，会导致严重的残疾、发病率和过早死亡。本申请的父母资助的研究(R01DA0191606)帮助确定了SUD的风险因素。已知的SUD危险因素包括家族史、不良父母教养、创伤经历、人格特征、最近的应激性生活事件、早发性药物使用、社会偏差和物质的可获得性。尽管最近在识别SUD风险因素方面取得了令人印象深刻的进展，但还没有开发和测试明确的模型来定义这些变量之间的相互关系。与NIDA的五年战略计划预防优先事项1“确定药物滥用的特征和模式”和2“了解基因、环境和发展如何影响药物滥用的各种风险和保护因素”以及交叉优先事项2“减少与药物成瘾有关的健康差距”相一致，在这一相互竞争的更新中，我们寻求建立一个理论驱动的、全面的SUD模型，并检验其在物质、种族和性别之间的不变性。我们将使用来自全国酒精及相关疾病流行病学调查(NESARC)第一波和第二波的34,653名参与者的数据。三个相辅相成的统计技术家族(GLM、Oaxaca类型分解和结构方程模型)将被用于指导基于Kendler教授的开创性研究的概念模型的开发，该研究侧重于严重抑郁障碍的风险因素，我们已经修改(例如，通过包括药物的可用性)来研究SUD的病因和病程。这个修正的肯德勒模型综合了五个发育阶段的变量：儿童期、青春期早期、青春期晚期、成年期和最后一年。该模型的风险因素在所有NESARC参与者中进行了评估，并被广泛认为适用于SUD。重要的是，许多风险因素是可以改变的，并且可以通过预防和治疗干预措施改变。我们建议使用修正的Kendler概念模型来检验以下目的：1)调查危险因素与药物使用的流行率之间的关系；2)确定危险因素与从使用到SUD的转变、SUD的缓解和复发之间的关系；3)检验SUD过程中的性别和种族差异是否由于危险因素的不同分布或差异作用；4)建立和检验药物使用、SUD的转变、SUD的缓解和复发的模型。在这项研究的结论中，我们将开发和测试一个模型，该模型集成了一系列关于SUD的发病和病程的危险因素。这些模型将有助于为SUD循证预防和治疗干预措施的开发和定向提供信息。

DESCRIPTION (provided by applicant): Substance use disorders (SUD) are highly prevalent and result in substantial disability, morbidity, and premature mortality. Research supported by the parent grant of this application (R01DA0191606) has helped to define risk factors for SUD. Known risk factors for SUD span family history, poor parenting, traumatic experiences, personality traits, and recent stressful life events, early-onset substance use, social deviance and availability of substances. Despite impressive recent progress on the identification of risk factors for SUD, no explicit model has been developed and tested that defines the interrelationships among these variables. Consistent with NIDA's Five Year Strategic Plan's Prevention Priorities 1 "To identify the characteristics and patterns of drug abuse" and 2 "To understand how genes, environment, and development influence the various risk and protective factors for drug abuse", and Cross-Cutting Priority 2 "To decrease health disparities related to drug addiction", in this competing renewal, we seek to build a theory-driven, comprehensive model of SUD and examine its invariance across substances, race, and gender. We will use data from the 34,653 participants in Waves 1 and 2 of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC). Three complementary families of statistical techniques (GLM, Oaxaca-type decompositions and structural equation models) will be applied to guide development of a conceptual model based on the pioneering research of Professor Kendler that focused on risk factors for major depressive disorder, and that we have modified (e.g., by including availability of drugs) to study the etiology and course of SUD. This modified Kendler model provides a comprehensive integration of variables from five developmental stages: childhood, early adolescence, late adolescence, adulthood, and the last year. The risk factors for this model were assessed in all NESARC participants and are widely considered to apply to SUD. Importantly, many of the risk factors are modifiable and amenable to change through prevention and treatment interventions. We propose to use the modified Kendler conceptual model to examine the following aims: 1) To investigate the relationship between risk factors and prevalence of substance use and SUD~ 2) To determine the relationship between risk factors and transition from use to SUD, remission of SUD, and relapse~ 3) To examine whether gender and racial/ethnic differences across the course of SUD are due to the differential distribution or differential effect of the risk factors~ and, 4) To develop and test models of substance use, SUD, transition from SUD, remission from SUD, and relapse. At the conclusion of this study, we will have developed and tested a model that integrates a broad range of risk factors for the onset and course of SUD. These models will help to inform the development and targeting of evidence-based prevention and treatment interventions for SUD.