Methamphetamine Abuse: Long-Term Trajectories, Correlates, Treatment Effects

描述（由申请人提供）：15年来，甲基苯丙胺（MA）在美国的使用和地理渗透迅速增加，其使用的后果引起了人们的关注，并增加了改进拦截、预防和治疗策略的努力，优先考虑研究以告知这些策略。关于MA滥用的生命过程的信息有限，特别是随着MA使用者年龄的增长。需要进一步的研究，为制定解决老年用户特有问题的战略提供经验支持。拟议的项目是对596名先前研究过的MA使用者的随访，其中一半是从药物治疗参与中招募的，一半来自同一社区，但在招募时没有接受过MA使用治疗。该项目将使用自然历史访谈收集数据，以增加这些MA使用者平均8年的物质使用，治疗和犯罪生涯的详细历史；这些新数据与以前收集的数据相结合，将产生平均至少28年的生命历程轨迹，涵盖青少年和成年时期。其他数据将来自几个州机构的行政记录。样本为35%女性/65%男性，33%西班牙裔/38%非西班牙裔白人/17%非洲裔美国人/12%其他种族。随访研究开始时，受试者年龄在28岁至74岁之间（平均42岁）。分析将描述MA的现状和长期使用历史，检查MA和其他药物使用的模式，包括升级、减速和可能的停止和恢复；检查药物治疗利用模式及其与MA使用模式的关系；确定健康发病率和死亡率，并评估存活和死亡用户之间的差异。该研究还将评估先前确定的药物治疗事件（从治疗中招募的子样本）的长期结果（14年或更长时间）。此外，该研究将从犯罪活动、监禁、药物治疗服务、卫生和精神卫生服务以及福利系统参与等方面估计样本滥用MA的累积社会成本；它将审查与MA使用的不同模式和用户特征相关的成本差异。分析方法将包括增长模型和增长混合模型，以评估MA使用轨迹及其与服务利用、其他事件和选定用户特征的关系。公共卫生相关性：这项后续研究的结果将提供有关甲基苯丙胺（MA）使用生命过程的更多细节，并为改进治疗推广、参与、服务提供和持续护理的策略提供经验基础。积累的知识将对政策产生影响，涉及临床思维转变为将MA依赖作为一种慢性疾病的长期管理，依赖的社会和健康负担，以及重要的是，成功停止MA使用的潜在益处。

DESCRIPTION (provided by applicant): A decade and a half of rapidly increasing use of and geographic penetration of methamphetamine (MA) across the U.S. and the consequences of its use have generated concern and increasing efforts to improve interdiction, prevention, and treatment strategies, with a priority on research to inform these strategies. Limited information is available regarding the life course of MA abuse, particularly as MA users age. Further research is needed to provide empirical support for developing strategies to address issues specific to older users. The proposed project is a follow-up of 596 previously studied MA users, half recruited from drug treatment participation, half from the same communities but with no prior treatment for MA use at recruitment. The project will collect data using the Natural History Interview to add an average of 8 years of detailed histories on substance use, treatment, and criminal careers of these MA users; these new data combined with previously collected data will produce life course trajectories averaging at least 28 years in duration, covering teen and adult periods. Additional data will come from administrative records from several state agencies. The sample is 35% female/65% male, 33% Hispanic/38% non-Hispanic White/17% African- American/12% other ethnicity. Subjects will range in age from about 28 to 74 (average 42) at beginning of the follow-up study. Analyses will describe the current status and extended MA use histories, examining patterns of MA and other drug use, including escalation, deceleration, and possible cessation and recovery; examine drug treatment utilization patterns and relationship to MA use patterns; and determine health morbidity and mortality and assess differences between surviving and deceased users. The study will also assess the long-term outcomes (14 or more years) of a previously identified drug treatment episode (for the subsample recruited from treatment). In addition, the study will estimate cumulative social costs of MA abuse for the sample in terms of criminal activity, incarceration, drug treatment services, health and mental health services, and welfare system participation; and it will examine differences in costs related to distinctive patterns of MA use and user characteristics. Analysis methods will include growth models and growth mixture models to assess MA use trajectories and their relationships to services utilization, other events, and selected user characteristics. PUBLIC HEALTH RELEVANCE: Findings from this follow-up study will provide additional detail on the life course of methamphetamine (MA) use and an empirical basis for improving strategies for treatment outreach, engagement, service delivery, and continuing care. The accumulated knowledge will have implications for policy regarding the shift in clinical thinking to the long-term management of MA dependence as a chronic disease, the social and health burden of dependence, and importantly, the potential benefits of successful cessation of MA use.