Comorbid Patterns with Alcohol Use Disorders

 描述(由申请人提供)：本次修订的R01续展申请是对名为“现有酒精流行病学数据的二次分析”的计划公告PAR-14-338的回应。这项应用的总体目标是评估酒精参与的模式与共病的非酒精物质使用症状和障碍，特别是评估这些共病条件的过渡模式，以及人口的亚群。尽管先前的基于人群的研究和临床研究提供了强有力的证据表明，酒精滥用和依赖与其他物质使用障碍并存，但相对较少的评估是，随着使用者在接触酒精和其他物质的不同阶段过渡，共病模式的评估。在过去的几十年里，酒精和烟草被认为是“门户”，是非法药物使用的早期先兆。然而，最近的监测趋势表明烟草使用量减少，而大麻使用量上升，非医疗用处方药的使用量大幅上升。在过去的十年里，成年人的饮酒量也有所增加。鉴于最近美国一些地区态度的改变和大麻限制的放松，以及更明显地获得非医疗用途的处方药，有必要提高我们对酒精和其他药物使用共病模式的理解。对于这一项目更新，我们的目标是评估涉及酒精和非酒精物质(尼古丁、非医疗处方阿片类药物使用、非医疗处方兴奋剂使用和大麻)的共存模式。具体地说，我们的目标是1)使用国家酒精纵向流行病学调查(NLAES)(1991-2)、国家酒精及相关疾病流行病学调查(NESARC)第1波(2001-2)和NESARC III(2012-3)的数据，评估过去20年期间酒精共患病的长期趋势。我们还旨在通过使用NESARC第一波和第二波的3年前瞻性数据以及全国共病调查(NCS)及其10年的随访，通过前瞻性地评估酒精和毒品的并存模式，利用潜伏期(LCA)和潜伏期分析(LTA)来进一步评估潜在的变化。3)基于问题行为理论中的概念，我们还将评估酒精和药物参与阶段的潜在进展预测因素，以及保护因素和与酒精和药物并存的更严重阶段的恢复相关的因素。我们建议的分析将按性别、种族-民族和青春期/青年成年期亚组检查共病模式。4)我们的目标是将先进的统计策略融入我们的分析中，并将倾向评分方法与LTA模型结合使用，以提高我们从观测数据中提取因果推理的能力。酒精和其他药物使用的共病非常普遍，拟议项目分析的结果应该会增加我们对这些重要的共病关联的了解，并提高我们确定预防和早期干预的潜在目标的能力。

 DESCRIPTION (provided by applicant): This revised R01 renewal application is in response to the Program Announcement PAR-14-338, entitled "Secondary Analysis of Existing Alcohol Epidemiology Data". The overall goals for this application are to assess patterns of alcohol involvement with comorbid non-alcohol substance use symptoms and disorders, specifically assessing transition patterns for these comorbid conditions, and for subgroups of the population. Although prior population-based and clinical studies have provided strong evidence for the comorbid occurrence of alcohol abuse and dependence with other substance use disorders, there has been relatively little assessment of patterns of comorbidity as users transition through different stages of involvement with alcohol and other substances. In prior decades, alcohol and tobacco were considered 'gateways', early antecedents to illegal substance use. However, recent surveillance trends indicate reduction in tobacco use, whereas marijuana use has risen, and non-medical use of prescription medications has taken a large upswing. Alcohol consumption in the past decade has also increased among adults. Given the changing attitudes and loosening of marijuana restrictions in the recent past in some areas of the US as well as greater apparent accessibility to non-medical use of prescription medications, there is a need to improve our understanding of patterns of alcohol and other drug use comorbidity. For this project renewal, we aim to assess the comorbid patterns involving alcohol and non-alcohol substances (nicotine, non-medical prescription opiod use, non- medical prescription stimulant use, and marijuana). Specifically we aim to 1) assess secular trends in alcohol comorbidity over the past 20 year period using data from the National Longitudinal Alcohol Epidemiologic Survey (NLAES) (1991-2), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) wave 1 (2001-2), and the NESARC III (2012-3). We also aim 2) to further evaluate potential changes over time by assessing comorbid patterns of alcohol and drug involvement prospectively with latent class (LCA) and latent transition analysis (LTA) using the 3-year prospective data from the NESARC waves 1 and 2, and the National Comorbidity Survey (NCS) and its 10-year follow-up. 3) Based on concepts in problem behavior theory, we will also assess potential predictors of progression through stages of alcohol and drug involvement, as well as protective factors and those associated with recovery from more severe stages of comorbid alcohol and drug use. Our proposed analyses will examine comorbid patterns by sex, race-ethnicity and for the adolescence/young adulthood subgroups. 4) We aim to incorporate advanced statistical strategies in our analyses, and use propensity score methods with LTA models to improve our ability to draw causal inferences from the observational data. Alcohol and other drug use comorbidity is highly prevalent, and findings from the proposed project analyses should increase our understanding of these important comorbid associations and improve our ability to identify potential targets for prevention and early intervention.