Natural Course and Developmental Trajectories of Alcohol Use Disorders

描述（由申请人提供）：酒精滥用和依赖性障碍在一般人群中很常见，保守估计表明，近五分之一的美国人在其一生中会出现酒精使用障碍（AUD）。与AUDs相关的公共卫生问题已得到充分记录;然而，关于AUDs在普通人群中的发展和过程，仍然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AUD相关发展轨迹的多样性，以及AUD轨迹与常见并发症（如大麻使用障碍，硬性药物使用障碍和反社会行为障碍）之间关系的时间和顺序。拟议的研究还将报告关于第一次AUD发作后复发概率的数据，以及第二次AUD发作患者的疾病复发时间。还将测试一个模型，以了解AUD的短期和长期结果，反过来，对持续恢复期后的复发相关过程有影响。为了实现这些研究目标，现有的数据集从俄勒冈州青少年抑郁症项目（OADP）将进行分析。OADP是一项以社区为基础的多代纵向研究，涵盖了从青少年到成年早期的危险酒精使用持续模式出现的高峰期。 本提案中所述的研究将解决OADP以前出版物中未涉及的若干问题。强调了四个广泛的领域，这些领域结合了OADP的纵向和发展特征。(1)将推导描述AUD首次发病年龄相关趋势的风险函数，并报告至痊愈时间、复发概率和至疾病复发时间的数据。(2)将根据AUD在一生中的发展过程确定人员亚组，并报告与不同轨迹亚组相关的儿童风险因素和成人心理社会结局。(3)将评价并记录AUD与其他相关疾病之间可能存在的单向和相互关系。(4)抑郁症将被评估为初始AUD后可能的“疤痕”，反过来预测未来复发的可能性。这项拟议研究的结果有可能为AUDs的流行病学理论提供信息，帮助开发筛查工具以识别未来有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制定，并降低复发的可能性一旦发生有益的行为改变。

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.