Pathways to Recovery: Older Substance Users

从历史上看，美国大多数患有物质使用障碍的人年龄在50岁以下。这一趋势正在发生变化，因为婴儿潮一代的物质障碍患病率创历史新高，进入50多岁和60多岁，预计到2020年，他们的治疗需求将第二次翻一番。 成瘾和艾滋病毒风险行为的后果预计将与自然衰老相关的脆弱性相互作用。虽然长期康复率随着年龄的增长而增加，但许多人将继续复发，并与缺乏适合年龄的服务的治疗系统相互作用。需要一个经验基础，为服务的发展和提供提供信息。很少有长期的研究存在的个人与慢性成瘾和治疗史;更少阐明慢性成瘾，艾滋病毒的危险行为和衰老之间的接口。最近的一项纵向研究（Scott & Dennis 2009）的初步分析表明，在348名报告有多个性伴侣的成年人中，299人（86%）在一个或多个季度（超过21个月）内停止与多个伴侣交往，但297人（85%）随后在某个时候重新与多个伴侣交往。在515名报告无保护措施性行为的成年人中，402人（78%）在一个或多个季度停止，但467人（91%）随后重新进行无保护措施性行为。在114名报告使用针头的成年人中，106名（94%）在一个或多个季度内停止使用针头，43名（38%）随后重新开始使用针头。此外，在任何一个特定季度，从事这些高风险行为的人中有三分之二不愿意立即接受治疗。因此，与一般物质使用的情况一样，这表明需要更好地了解艾滋病毒风险行为随时间推移的明显周期性。 拟议的研究通过利用以前的NIDA资助的纵向研究来针对这一差距，该研究在1996年至1998年期间重新评估了1，326名接受公共资助的药物滥用治疗的人，并在2007年之前重新评估了9次（90%+保留/波）。最初的性别平衡样本主要由少数民族成员组成，他们有多种物质使用的长期历史，包括可卡因（64%），酒精（44%），阿片类药物（41%）或大麻（14%）。入组时，平均年龄为35岁（4% 50+），9岁时为44岁（18% 50+），拟定研究开始时为49岁（42% 50+），结束时为54岁（53% 50+）。该项目将通过在摄入后14、15、16、17和18年增加年度访谈来扩展原始研究，以建立迄今为止同类最长和最大的治疗队列研究之一。The cohort的全面历史，在早期的浪潮中捕获，与新的前瞻性信息相结合，提供了一个具有成本效益和难得的机会来确定因素，以帮助最大限度地减少物质使用和健康领域的老化负担。研究目的是：1）确定是否有与年龄有关的变化，预计随着时间的推移，因素的预测值增加（包括首次使用的年龄，清醒的朋友数量，接受的治疗）和减少（包括严重程度、精神痛苦、法律的参与、HIV风险行为）在未来12个月内开始/维持禁欲的可能性;（2）确定预计随着时间的推移而增加的因素的预测值是否存在与年龄相关的变化（例如，先前禁欲，是女性，自助参与）和减少（例如，先前治疗发作次数、无家可归和逮捕次数、HIV危险行为）再保持禁欲12个月的可能性;（3）为了测试预期随着时间的推移而降低的变量的预测值是否存在与年龄相关的变化（例如，损失，悲伤，艾滋病毒风险行为，功能，残疾）和增加（例如，活动水平、生活质量、社会支持）从戒断3年到晚期复发的时间，（4）评估再加工的累积模式对未来关键的积极和消极健康结果的影响是否存在年龄相关的变化（例如，生活质量、功能、残疾、死亡），（5）评估HIV危险行为的累积模式对未来HIV状态和其他健康结果的影响是否存在与年龄相关的变化。

Historically, the majority of people with substance use disorders in the US has been under age 50. This trend is changing as baby boomers with record high prevalence rates of substance disorders, enter their 50s and 60s, and their demand for treatment is expected to double for the second time by 2020. Consequences of addiction and HIV risk behaviors are expected to interact with vulnerabilities associated with natural aging. While rates of long-term recovery increase with age, many will continue to relapse and interact with treatment systems lacking in age-appropriate services. An empirical basis is needed to inform service development and delivery. Few long-term studies of individuals with chronic addiction and treatment histories exist; even fewer elucidate the interface between chronic addiction, HIV risk behaviors and aging. Preliminary analyses from a recent longitudinal study (Scott & Dennis 2009) indicated that among 348 adults who reported multiple sexual partners, 299 (86%) stopped engaging with multiple partners during one or more quarters (over 21 months), but 297 (85%) subsequently re-engaged at some point with multiple partners. Among the 515 adults who reported unprotected sex, 402 (78%) stopped during one or more quarters, but 467 (91%) subsequently re-engaged in unprotected sex. Among the 114 adults who reported needle use, 106 (94%) stopped during one or more quar-ters, with 43 (38%) subsequently reinitiated needle use. Moreover 2/3rds of those engaging in these high-risk behaviors in any given quarter were not immediately willing to enter treatment. Thus, as is the case for sub-stance use in general, this suggests the need to better understand the apparent cyclical nature of HIV risk behaviors over time. The proposed study targets this gap by capitalizing on a previous NIDA-funded longitudinal study that re-cruited 1,326 people presenting to publicly funded substance abuse treatment between 1996 and 1998 and re-assessed 9 times through 2007 (90%+ retention/wave). The original gender-balanced sample consisted largely of ethnic minority members with chronic histories of polysubstance use including cocaine (64%), alcohol (44%), opioids (41%), or marijuana (14%). At intake, the mean age was 35 years (4% 50+), at 9 years it was 44 (18% 50+), at the start of the proposed study it will be 49 (42% 50+) and at the close 54 (53% 50+). This project will extend the original study by adding annual interviews at 14, 15, 16, 17, and 18 years post intake to establish one of the longest and largest treatment cohort studies of its type to date. The cohort¿s comprehensive history, captured in earlier waves, paired with new prospective information, offers a cost-effective and rare opportunity to identify factors to help minimize the burden of aging on the substance use and heath fields. Study aims are to: 1) Determine if there are age-related changes in the predictive value of factors expected over time to in-crease (including age of first use, number of sober friends, treatment received) and decrease (including severi-ty, mental distress, legal involvement, HIV risk behaviors) the likelihood of initiating/maintaining abstinence over the next 12 months; (2) Determine if there are age-related changes in the predictive value of factors expected over time to increase (e.g., prior abstinence, being female, self-help engagement) and decrease (e.g., number of prior treatment episodes, homelessness, and number of arrests, HIV risk behaviors) the likelihood of maintaining abstinence another 12 months; (3) To test whether there are age-related changes in the predictive value of variables expected over time to decrease (e.g., loss, grief, HIV risk behaviors, functioning, disability) and increase (e.g., activity level, quality of life, social support) the time from 3 years of abstinence to late stage relapse, (4) To evaluate whether there are age-related changes in the impact of the cumulative pattern of re-covery on future critical positive and negative health outcomes (e.g., quality of life, functioning, disability, death), (5) To evaluate whether there are age related changes in the impact of the cumulative pattern of HIV risk behaviors on future HIV status and other health outcomes.