Alcohol Use Disorders Across the Lifespan: Subtypes, Course, Comorbidity

描述(由申请人提供)：这是对修订申请(1 R01 AA016392-01A1)的修订，是对NIAAA计划公告(05-088)现有酒精流行病学数据的二级分析的回应，并由BGE IRG在其2006年10月的会议上进行审查。在这次修订中，我们试图解决最初提交的材料审查者提出的问题，同时保持我们最初的主要目标，即通过利用国家酒精及相关条件流行病学调查(NESARC)研究的独特方面，包括广泛的精神病理学评估(包括Axis I和Axis II障碍)、基于人群的抽样、大样本(~43,000人)、成人年龄跨度的覆盖范围和为期三年的纵向随访，将酒精使用障碍(AUD)的结构和病程描述为青少年和成人后期发育的功能。我们的主要关注点是AUDS的心理测量学结构和过程(例如，发病、进展、消退和缓解/停止)作为发展的函数(按年龄段)。尽管酒精研究人员越来越多地将AUDS视为发育障碍，但对于依赖综合征的结构(无论是从维度上还是从绝对上进行评估)是否作为发育的函数而变化，以及各种协变量在决定人生不同阶段的进程中所起的作用，人们知之甚少。除了关注年龄作为从测量和预后角度理解AUDS的关键基础外，我们还计划研究其他主要人口统计因素(即性别和种族/民族)和临床变量(即Axis I和Axis II病理)如何与年龄相互作用，以影响AUDS的结构和进程。我们特别感兴趣的是通过使用NESARC对人格病理的评估来扩展之前的工作，这是这个数据集的一个独特方面。我们相信人格病理学在AUDS的病因和病程中扮演着重要但认识不足的角色，并计划进行广泛和系统的分析，以描绘AUD/人格障碍(Axis II)共病的性质。由于Axis I“临床综合征”和Axis II疾病之间的共患率很高，目前尚不清楚现有关于AUD与Axis I疾病共病的文献在多大程度上代表了一种病理假象。只有通过全面同时模拟Axis I和Axis II的病理，我们才能在一定程度上解决各种共病综合征与AUDS在统计学上的独特关系。除了研究项目的实质性目标外，我们还建议开发和改进表征酒精相关综合征的方法，并研究它们随着时间的推移的稳定性。我们相信，这些心理测量学调查可以为临床病理学家和对新表型感兴趣的研究人员提供信息，这些表型可能在遗传学研究中有用。 与公共卫生相关：酒精使用障碍(AUD)是美国最普遍的心理障碍之一，给受影响的个人、他们的朋友和家人以及整个社会带来巨大负担。虽然AUDS主要是青春期和成年期早期的一种障碍，但在整个成年过程中，AUDS代表着巨大的健康挑战。这项拟议的研究试图将AUDS的发展和过程中的重要因素表征为成人发展阶段的功能，以便更好地理解AUDS在发育背景下的原因和后果。

DESCRIPTION (provided by applicant): This is a revision of an amended application (1 R01 AA016392-01A1) written in response to NIAAA Program Announcement (05-088) Secondary Analysis of Existing Alcohol Epidemiology Data and reviewed by the BGES IRG at its October, 2006, meeting. In this revision, we have attempted to address concerns raised by the reviewers of the initial submission while maintaining our original primary goals which involve characterizing the structure and course of alcohol use disorders (AUDs) as a function of late adolescent and adult development by exploiting the unique aspects of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) study which include extensive assessment of psychopathology (including both Axis I and Axis II disorders), population-based sampling, large (~43,000 individuals) sample size, coverage of the adult age span, and three-year longitudinal follow-up. Our main focus is on the psychometric structure and course (e.g., onset, progression, regression, and remission/desistence) of AUDs as a function of development (chronological age). Although alcohol researchers increasingly view AUDs as developmental disorders, little is known about whether the structure of the dependence syndrome (assessed either dimensionally or categorically) varies as a function of development and the role that various covariates play in determining course at different points along the lifespan. In addition to focusing on age as critical scaffolding for understanding AUDs from both a measurement and prognostic perspective, we plan to examine how other major demographic (i.e., sex and race/ethnicity) and clinical variables (i.e., Axis I and Axis II pathology) interact with age to affect the structure and course of AUDs. We are particularly interested in extending previous work by using the NESARC's assessment of personality pathology, a unique aspect of this data set. We believe personality pathology plays an important but under-recognized role in the etiology and course of AUDs, and plan extensive and systematic analyses to portray the nature of AUD/personality disorder (Axis II) comorbidity. Because of the high comorbidity between Axis I "clinical syndromes" and Axis II disorders, it is unclear to what extent the existing literature on AUD comorbidity with Axis I disorders represents an artifact of pathology. Only by comprehensively and simultaneously modeling both Axis I and Axis II pathology can we resolve the extent that various comorbid syndromes have a statistically unique relation with AUDs. In addition to the substantive goals of the research project, we also propose to develop and refine methodologies for characterizing alcohol-related syndromes and studying their stabilities over time. We believe these psychometric investigations can inform both clinical nosology and researchers interested in novel phenotypes that may be useful in genetic investigations. Relevance to public health: Alcohol use disorders (AUDs) are among the most prevalent psychological disorders in the Nation and produce substantial burden to affected individuals, their friends and families, and society at large. Although primarily a disorder of adolescence and early adulthood, AUDs represent significant health challenges throughout the course of adulthood. The proposed study seeks to characterize factors important in the development and course of AUDs as a function of stage of adult development in order to better understand the causes and consequences of AUDs in a developmental context.