Comorbid Patterns with Alcohol Use Disorders

 描述（由申请人提供）：此修订的R 01更新申请是对计划公告PAR-14-338的回应，标题为“现有酒精流行病学数据的二次分析”。本申请的总体目标是评估酒精与共病非酒精物质使用症状和障碍的关系模式，特别是评估这些共病状况和人群亚组的过渡模式。尽管先前的基于人群的临床研究提供了酒精滥用和依赖与其他物质使用障碍共病发生的强有力证据，但随着用户在酒精和其他物质参与的不同阶段过渡，对共病模式的评估相对较少。在过去的几十年里，酒精和烟草被认为是非法物质使用的“入口”。然而，最近的监测趋势表明，烟草使用减少，而大麻使用增加，处方药的非医疗使用大幅上升。过去十年中，成年人的酒精消费量也有所增加。考虑到最近美国某些地区态度的变化和大麻限制的放松，以及处方药的非医疗用途的明显可及性，有必要提高我们对酒精和其他药物使用并发症模式的理解。对于本项目更新，我们旨在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）的共病模式。具体而言，我们的目标是：1）使用国家纵向酒精流行病学调查（NLAES）（1991-2），国家酒精和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年期间酒精合并症的长期趋势。我们还旨在2）通过使用NESARC第1波和第2波的3年前瞻性数据，以及国家科摩罗调查（NCS）及其10年随访，前瞻性地评估酒精和药物参与的共病模式（LCA）和潜在转换分析（LTA），进一步评估随时间推移的潜在变化。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进展的潜在预测因素，以及保护因素和与酒精和药物使用共病的更严重阶段恢复相关的因素。我们提出的分析将检查共病模式的性别，种族，民族和青少年/青年成年亚组。4)我们的目标是在我们的分析中采用先进的统计策略，并使用倾向评分方法与LTA模型，以提高我们从观察数据中得出因果推断的能力。酒精和其他药物使用的合并症是非常普遍的，从拟议的项目分析的结果应该增加我们对这些重要的合并症协会的理解，提高我们的能力，以确定潜在的目标，预防和早期干预。

 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.