Longitudinal trends in alcohol use and AUDs among rural stimulant users

描述(由申请人提供)：本申请是对NIAAA关于现有酒精流行病学数据二次分析的计划公告(PA-08-169)的回应。这项应用的首要目标是加强我们对甲基苯丙胺和可卡因使用者酒精使用的纵向模式和趋势的了解。以前关于酒精和兴奋剂使用的流行病学研究大多依赖于横断面调查或基于治疗的样本的数据。关于兴奋剂使用者，特别是甲基苯丙胺使用者的社区样本中酒精使用的自然历史的信息很少，因为他们中的许多人没有获得正式的药物滥用服务。最令人关切的问题是，随着时间的推移，酒精是否被用作可卡因和/或甲基苯丙胺的补充或替代品，以及可卡因和/或甲基苯丙胺的使用是否与出现/维持或缓解酒精使用障碍的风险有关。为了解决这些问题，我们建议对NIDA资助的农村兴奋剂研究(RSS)中收集的与酒精有关的数据进行广泛的二级统计分析。RSS是一项非常独特的多州、以社区为基础和纵向的自然历史研究(3年内进行了7次访谈)，研究对象为710名在研究登记时最近或现在使用可卡因和/或甲基苯丙胺的人。虽然作为RSS的一部分，每隔6个月对酒精使用频率和数量以及酒精使用障碍(AUD)的诊断进行一次评估，但最初的赠款没有任何与酒精有关的具体目标或假设。我们的具体研究目的是(1)调查酒精使用的自然历史以及随着时间的推移可卡因和/或甲基苯丙胺可能被酒精取代，以及(2)调查可卡因和MA使用之间的纵向关系和酒精使用障碍(AUD)的风险。我们选择将R03应用集中在这些目标上，因为它们代表了重要的未解答问题，不符合原始家长研究的目标。拟议研究的另一个优势是，样本由居住在农村地区的兴奋剂使用者组成，这是一个历史上研究不足的群体，在药物滥用研究中也没有得到充分的代表。总之，拟议的研究将使我们有机会对一个独特的数据集进行量化分析，从而以非常经济有效的方式增进我们对酒精和兴奋剂使用之间纵向相互作用的理解。研究结果有可能有助于改善目前或过去使用兴奋剂的人的酒精使用预防和治疗。公共卫生相关性：拟议的研究对酒精和兴奋剂的使用具有重要的公共卫生意义，特别是在美国农村，那里的可卡因和甲基苯丙胺的使用正在迅速增加。进一步了解酒精和兴奋剂使用之间的相互作用，包括酒精是否被用作可卡因和/或甲基苯丙胺的替代品，有助于改进药物滥用的预防和治疗。

DESCRIPTION (provided by applicant): This application is in response to the NIAAA program announcement (PA-08-169) on Secondary Analysis of Existing Alcohol Epidemiology Data. The overarching goal of this application is to enhance our understanding of the longitudinal patterns and trends of alcohol use among methamphetamine and cocaine users. Most prior research on the epidemiology of alcohol and stimulant use has relied on data from cross-sectional surveys or treatment-based samples. There is very little information about the natural history of alcohol use among community-based samples of stimulant users, particularly methamphetamine users, many of whom do not access formal substance abuse services. Of key concern is whether alcohol is used a complement or substitute to cocaine and/or methamphetamine over time and whether cocaine and/or methamphetamine use is associated with the risk of developing/maintaining or remitting from an alcohol use disorder (AUD). To address these issues, we propose to conduct extensive secondary statistical analyses of alcohol-related data collected as part of the NIDA-funded Rural Stimulant Study (RSS). The RSS is a very unique multi-state, community-based, and longitudinal (7 interviews over 3 years) natural history study of 710 persons who were recent or current users of cocaine and/or methamphetamine at the time of study enrollment. While numerous measures of the frequency and quantity of alcohol use as well as diagnoses of alcohol use disorders (AUDs) were assessed at 6-month intervals as part of the RSS, the original grant did not contain any specific aims or hypotheses pertaining to alcohol. Our specific research aims are to (1) Investigate the natural history of alcohol use and potential substitution of cocaine and/or methamphetamine with alcohol over time and (2) Investigate the longitudinal relationships between cocaine and MA use and the risk of an alcohol use disorder (AUD). We have chosen to focus this R03 application on these aims because they represent important unanswered questions and do not fall within the aims of the original parent study. An additional strength of the proposed study is that the sample is comprised of stimulant users residing in rural areas, a subpopulation that is historically understudied and underrepresented in substance abuse research. In summary, the proposed study will afford us the opportunity to conduct quantitative analyses of a unique data set and thus advance our understanding of the longitudinal interplay between alcohol and stimulant use in a very cost effective manner. The research findings have the potential to contribute to improvements in alcohol use prevention and treatment among current or past stimulant users. PUBLIC HEALTH RELEVANCE: The proposed research has important public health significance regarding alcohol and stimulant use, particularly in rural America, which is experiencing a rapid increase in the use of cocaine and methamphetamine. Further understanding of the interplay between alcohol and stimulant use over time, including whether alcohol is used as a substitute for cocaine and/or methamphetamine, could contribute to improvements in substance abuse prevention and treatment.